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Franco Z, Ruffalo L, Curry B, Gollin-Graves M, Ahamed SI, Winstead O, Hooyer K, Pazdera M, Rein L, Lizarraga Mazaba J, Hossain MF, Stoffel V, Flower M, Madiraju P, Melka S, Berte K, Whittle J. Impact of veteran-led peer mentorship on posttraumatic stress disorder. J Trauma Stress 2024; 37:617-630. [PMID: 38635149 DOI: 10.1002/jts.23038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/05/2024] [Accepted: 03/23/2024] [Indexed: 04/19/2024]
Abstract
Peer mentorship shows promise as a strategy to support veteran mental health. A community-academic partnership involving a veteran-led nonprofit organization and institutions of higher education evaluated a collaboratively developed peer mentor intervention. We assessed posttraumatic stress disorder (PTSD), postdeployment experiences, social functioning, and psychological strengths at baseline, midpoint, and 12-week discharge using the PTSD Checklist for DSM-5 (PCL-5), Deployment Risk and Resilience Inventory-2, Social Adaptation Self-evaluation Scale, and Values in Action Survey. Brief weekly check-in surveys reinforced mentor contact and assessed retention. The sample included 307 veterans who were served by 17 veteran peer mentors. Mixed-effects linear models found a modest effect for PTSD symptom change, with a mean PCL-5 score reduction of 4.04 points, 95% CI [-6.44, -1.64], d = 0.44. More symptomatic veterans showed a larger effect, with average reductions of 9.03 points, 95% CI [-12.11, -5.95], d = 0.77. There were no significant findings for other outcome variables. Compared to younger veterans, those aged 32-57 years were less likely to drop out by 6 weeks, aORs = 0.32-0.26. Week-by-week hazard of drop-out was lower with mentors ≥ 35 years old, aHR = 0.62, 95% CI [0.37, 1.05]. Unadjusted survival differed by mentor military branch, p = .028, but the small mentor sample reduced interpretability. Like many community research efforts, this study lacked a control group, limiting the inferences that can be drawn. Continued study of veteran peer mentorship is important as this modality is often viewed as more tolerable than therapy.
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Affiliation(s)
- Zeno Franco
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Leslie Ruffalo
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bob Curry
- Great Lakes Dryhootch, Milwaukee, Wisconsin, USA
| | | | - Sheikh Iqbal Ahamed
- Department of Computer Science, Marquette University, Milwaukee, Wisconsin, USA
| | | | - Katinka Hooyer
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Myah Pazdera
- Office of Community Engagement, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lisa Rein
- Institute for Health & Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jose Lizarraga Mazaba
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Md Fitrat Hossain
- Department of Computer Science, Marquette University, Milwaukee, Wisconsin, USA
| | - Virginia Stoffel
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Mark Flower
- Mental Health America of Wisconsin, Milwaukee, Wisconsin, USA
| | - Praveen Madiraju
- Department of Computer Science, Marquette University, Milwaukee, Wisconsin, USA
| | - Stephen Melka
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Karen Berte
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Jeffrey Whittle
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
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Vivian EM, Chewning BA, Voils CI, Brown RL. Healthy Outcomes through Peer Educators: Feasibility of a peer support diabetes prevention programme for African-American grandmother caregivers. Diabetes Obes Metab 2024; 26:2598-2605. [PMID: 38567410 DOI: 10.1111/dom.15574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
AIM To assess the protocol feasibility and intervention acceptability of a community-based, peer support diabetes prevention programme (DPP) for African-American (AA) grandmother caregivers at risk for diabetes. MATERIALS AND METHODS Grandmother caregivers were randomized in a 2:1 ratio to DPP (active comparator) or DPP plus HOPE (Healthy Outcomes through Peer Educators; intervention). DPP + HOPE incorporated support from a peer educator who met with participants in person or by telephone every week during the 1-year intervention. Outcomes included: (1) recruitment rates, outcome assessment, and participation adherence rates assessed quantitatively; and (2) acceptability of the programme assessed through end-of-programme focus groups. RESULTS We successfully consented and enrolled 78% (n = 35) of the 45 AA grandmothers screened for eligibility. Eighty percent of participants (aged 64.4 ± 5.7 years) were retained up to Week 48 (74% for DPP [n = 17] and 92% for DPP + HOPE [n = 11]). All grandmothers identified social support, neighbourhood safety, and access to grocery stores as influences on their health behaviours. At Month 12, the active comparator (DPP) group and the intervention group (DPP + HOPE) had a mean change in body weight from baseline of -3.5 ± 5.5 (-0.68, -6.29) kg and - 4.4 ± 5.7 (-0.59, -8.2) kg, respectively. CONCLUSIONS This viable study met the aim of educating and equipping AA grandmothers with the practical and sustained support needed to work toward better health for themselves and their grandchildren, who may be at risk for diabetes. The intervention was both feasible and acceptable to participating grandmothers and their organizations.
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Affiliation(s)
- Eva M Vivian
- University of Wisconsin Madison School of Pharmacy, Madison, Wisconsin, USA
| | - Betty A Chewning
- University of Wisconsin Madison School of Pharmacy, Madison, Wisconsin, USA
| | - Corrine I Voils
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Roger L Brown
- University of Wisconsin School of Nursing and School of Medicine and Public Health, Madison, Wisconsin, USA
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Carrandi A, Hu Y, McGill K, Wayland S, Karger S, Maple M. Operationalizing the Consolidated Framework for Implementation Research to build and support the lived experience workforce in direct health service provision. Health Expect 2024; 27:e14035. [PMID: 38567878 PMCID: PMC10989156 DOI: 10.1111/hex.14035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 02/27/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND The involvement of people with lived experience (LEX) workers in the development, design, and delivery of integrated health services seeks to improve service user engagement and health outcomes and reduce healthcare gaps. Yet, LEX workers report feeling undervalued and having limited influence on service delivery. There is a need for systematic improvements in how LEX workforces are engaged and supported to ensure the LEX workforce can fully contribute to integrated systems of care. OBJECTIVE This study aimed to operationalize the Consolidated Framework for Implementation Research (CFIR) using a rigorous scoping review methodology and co-creation process, so it could be used by health services seeking to build and strengthen their LEX workforce. SEARCH STRATEGY A systematic literature search of four databases was undertaken to identify peer-reviewed studies published between 2016 and 2022 providing evidence of the inclusion of LEX workers in direct health service provision. DATA EXTRACTION AND SYNTHESIS A descriptive-analytical method was used to map current evidence of LEX workers onto the CFIR. Then, co-creation sessions with LEX workers (n = 4) and their counterparts-nonpeer workers (n = 2)-further clarified the structural policies and strategies that allow people with LEX to actively participate in the provision and enhancement of integrated health service delivery. MAIN RESULTS Essential components underpinning the successful integration of LEX roles included: the capacity to engage in a co-creation process with individuals with LEX before the implementation of the role or intervention; and enhanced representation of LEX across organizational structures. DISCUSSION AND CONCLUSION The adapted CFIR for LEX workers (CFIR-LEX) that was developed as a result of this work clarifies contextual components that support the successful integration of LEX roles into the development, design, and delivery of integrated health services. Further work must be done to operationalize the framework in a local context and to better understand the ongoing application of the framework in a health setting. PATIENT OR PUBLIC CONTRIBUTION People with LEX were involved in the operationalization of the CFIR, including contributing their expertise to the domain adaptations that were relevant to the LEX workforce.
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Affiliation(s)
- Alayna Carrandi
- Social Work, School of HealthUniversity of New EnglandArmidaleAustralia
- School of Public Health and Preventive Medicine, Department of Epidemiology & Preventative MedicineMonash UniversityMelbourneAustralia
| | - Yanan Hu
- Social Work, School of HealthUniversity of New EnglandArmidaleAustralia
- Women's Health Economics and Value Based Care, Monash Centre for Health and Research and ImplementationMonash UniversityClaytonAustralia
| | - Katherine McGill
- Social Work, School of HealthUniversity of New EnglandArmidaleAustralia
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- Healthy Minds, Hunter Medical Research InstituteNewcastleAustralia
- Mental Health‐Research, Evaluation and Dissemination (MH‐READ), Hunter New England Local Health DistrictNewcastleAustralia
| | - Sarah Wayland
- Social Work, School of HealthUniversity of New EnglandArmidaleAustralia
| | - Shae Karger
- Social Work, School of HealthUniversity of New EnglandArmidaleAustralia
- Women's Health Economics and Value Based Care, Monash Centre for Health and Research and ImplementationMonash UniversityClaytonAustralia
| | - Myfanwy Maple
- Social Work, School of HealthUniversity of New EnglandArmidaleAustralia
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Liu Y, Cai C, Wu X, Tang PY, Maggy Coufal M, Chen H, Shen L, Yu W, Qian Y, Luu S, Fisher EB, Jia W. Benefits of 12-month peer support for diabetes self management sustained at 18 months. Diabetes Res Clin Pract 2024; 209:111564. [PMID: 38336218 DOI: 10.1016/j.diabres.2024.111564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
AIMS To evaluate sustainability of peer support (PS) benefits in diabetes management. METHODS Supporting a Peer Leader program through Community Health Centers (CHCs) included trainings and consultations from baseline to 12 months. Evaluation at baseline, 12-month, and 18-month follow-up included primary outcome, HbA1c, and other outcomes of SBP, DBP, LDLc, PHQ-8, diabetes distress, and EQ-5D. RESULTS 1284 participants with type 2 diabetes mellitus were recruited from 9 CHCs. Mean (SD) for age = 68.00 (7.55) years, 43.07 % male, mean (SD) for diabetes duration = 11.79 (7.34) years. Across 18-months, linear mixed model analyses controlling for confounders found the least square mean (SE) of HbA1c improved significantly from 7.62 % (0.06 %) to 7.53 % (0.06 %) for all, and from 9.25 % (0.09 %) to 8.52 % (0.11 %) among those ≥8 % at baseline. Parallel improvements were found among all for SBP, DBP, PHQ-8, diabetes distress, and, among those elevated at baseline for all outcomes. EQ-5D showed significant but modest increase from baseline to 18 months. No significant reversals between 12 and 18 months were found except for LDLc. Supporting robustness of findings, patterns were similar across age, diabetes duration, and gender. CONCLUSIONS Relative to the fundamentally progressive nature of diabetes, it is striking that improvements associated with PS were generally sustained after program support ended.
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Affiliation(s)
- Yuexing Liu
- Shanghai Diabetes Institute, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Technical Center for Diabetes Prevention and Clinical Care, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Research Center for Endocrine and Metabolic Diseases, Shanghai Municipal Key Clinical Specialty, 200233, China.
| | - Chun Cai
- Shanghai Diabetes Institute, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Technical Center for Diabetes Prevention and Clinical Care, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Research Center for Endocrine and Metabolic Diseases, Shanghai Municipal Key Clinical Specialty, 200233, China.
| | - Xiaoyu Wu
- Department of Health Promotion, Shanghai Municipal Health Commission, Shanghai 200125, China.
| | - Patrick Y Tang
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC 27599-7440, USA.
| | - Muchieh Maggy Coufal
- Asian Center for Health Education, 3916 Gettysburg Circle, Plano, TX 75023, USA.
| | - Hongli Chen
- Shanghai Diabetes Institute, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Technical Center for Diabetes Prevention and Clinical Care, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Research Center for Endocrine and Metabolic Diseases, Shanghai Municipal Key Clinical Specialty, 200233, China.
| | - Li Shen
- Shanghai Diabetes Institute, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Technical Center for Diabetes Prevention and Clinical Care, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Research Center for Endocrine and Metabolic Diseases, Shanghai Municipal Key Clinical Specialty, 200233, China.
| | - Wenya Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China.
| | - Yiqing Qian
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC 27599-7440, USA.
| | - Samantha Luu
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC 27599-7440, USA.
| | - Edwin B Fisher
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC 27599-7440, USA.
| | - Weiping Jia
- Shanghai Diabetes Institute, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Technical Center for Diabetes Prevention and Clinical Care, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Research Center for Endocrine and Metabolic Diseases, Shanghai Municipal Key Clinical Specialty, 200233, China.
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Ferrari G, Ngoga G, Manzi A, Gomber A. Peer Support in the Management of Diabetes to Improve Cardiovascular Disease Outcomes in Low- and Middle-Income Countries (LMICs). Glob Heart 2023; 18:48. [PMID: 37720310 PMCID: PMC10503527 DOI: 10.5334/gh.1263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023] Open
Abstract
Diabetes and cardiovascular disease (CVD) contribute to significant morbidity and mortality in low-resource settings. Living with diabetes can be overwhelming, isolating, and exhausting, even in settings of resource availability and health care access, while the psychosocial burden of living with diabetes and CVD can be exacerbated by an increased burden of social determinants of health in low-resource settings. Diabetes and CVD care heavily rely on self-management, and health care professionals are now recognizing the importance of peer support in supporting healthy behaviors, psychosocial well-being, and improved clinical outcomes. However, there is currently a lack of consistency in how peer support programs are defined, implemented, and evaluated.
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Affiliation(s)
- Gina Ferrari
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Gedeon Ngoga
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Partners In Health (PIH), Rwanda
| | | | - Apoorva Gomber
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Haregu T, Aziz Z, Cao Y, Sathish T, Thankappan KR, Panniyammakal J, Absetz P, Mathews E, Balachandran S, Fisher EB, Oldenburg B. A peer support program results in greater health benefits for peer leaders than other participants: evidence from the Kerala diabetes prevention program. BMC Public Health 2023; 23:1175. [PMID: 37337201 PMCID: PMC10278268 DOI: 10.1186/s12889-023-16049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 06/03/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Peer support programs are promising approaches to diabetes prevention. However, there is still limited evidence on the health benefits of peer support programs for lay peer leaders. PURPOSE To examine whether a peer support program designed for diabetes prevention resulted in greater improvements in health behaviors and outcomes for peer leaders as compared to other participants. METHODS 51 lay peer leaders and 437 participants from the Kerala Diabetes Prevention Program were included. Data were collected at baseline, 12 months, and 24 months. We compared behavioral, clinical, biochemical, and health-related quality of life parameters between peer leaders and their peers at the three time-points. RESULTS After 12 months, peer leaders showed significant improvements in leisure time physical activity (+ 17.7% vs. + 3.4%, P = 0.001) and health-related quality of life (0.0 vs. + 0.1, P = 0.004); and a significant reduction in alcohol use (-13.6% vs. -6.6%, P = 0.012) and 2-hour plasma glucose (-4.1 vs. + 9.9, P = 0.006), as compared to participants. After 24 months, relative to baseline, peer leaders had significant improvements in fruit and vegetable intake (+ 34.5% vs. + 26.5%, P = 0.017) and leisure time physical activity (+ 7.9% vs. -0.9%, P = 0.009); and a greater reduction in alcohol use (-13.6% vs. -4.9%, P = 0.008), and waist-to-hip ratio (-0.04 vs. -0.02, P = 0.014), as compared to participants. However, only the changes in fruit and vegetable intake and waist-to-hip ratio were maintained between 12 and 24 months. CONCLUSION Being a peer leader in a diabetes prevention program was associated with greater health benefits during and after the intervention period. Further studies are needed to examine the long-term sustainability of these benefits.
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Affiliation(s)
- Tilahun Haregu
- Baker Heart and Diabetes Institute, Melbourne, Australia.
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia.
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Zahra Aziz
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Yingting Cao
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | | | | | - Jeemon Panniyammakal
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute of Medical Science and Technology, Kerala, India
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Elezebeth Mathews
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | | | - Edwin B Fisher
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Brian Oldenburg
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Ayala GX, Canale K, Ibarra L, Parada H, Crespo NC, Pérez R, Horton LA, Cherrington A. Facilitators of peer leader retention within a Type 2 diabetes intervention trial for US Latinos/Hispanics of Mexican origin. HEALTH EDUCATION RESEARCH 2023; 38:204-219. [PMID: 36848036 PMCID: PMC10203040 DOI: 10.1093/her/cyad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 12/06/2022] [Accepted: 01/30/2023] [Indexed: 05/24/2023]
Abstract
Peer support is effective in improving self-management behaviors and health outcomes among individuals with Type 2 diabetes. Volunteer peer support programs offer a cost-effective resource for diabetes self-management support; however, factors affecting the retention of volunteer peer leaders remain understudied. Herein, we examined factors associated with volunteer retention and satisfaction among 34 predominantly Mexican-origin peer leaders who assisted patients from a Federally Qualified Health Center located on the US/Mexico border with their diabetes management. Peer leaders completed surveys with open- and close-ended questions at baseline, 6 months and 12 months. Quantitative and qualitative data analyses were guided by the Volunteer Process Model. Using nonparametric Mann-Whitney U tests, self-efficacy as a peer leader at 6 months was most associated with interest to continue volunteering (P = 0.01), and satisfaction with support from the program at 12 months was most associated with interest to continue volunteering (P = 0.01). The qualitative data indicated that the relationship between the peer leaders and their patients was the primary factor for a satisfying volunteer experience. Future research should focus on increasing peer leaders' self-efficacy and satisfaction with program support and examine how organizations can support the development of the patient-peer relationship. Practitioners should consider appealing to volunteer peers' motivations to promote their retention.
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Affiliation(s)
- G X Ayala
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA 92123, USA
| | - K Canale
- School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - L Ibarra
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 221, San Diego, CA 92123, USA
| | - H Parada
- School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - N C Crespo
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA 92123, USA
| | - R Pérez
- Department of Anthropology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - L A Horton
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 221, San Diego, CA 92123, USA
| | - A Cherrington
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham, AL 35205, USA
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Litchfield I, Calvert MJ, Kinsella F, Sungum N, Aiyegbusi OL. "I just wanted to speak to someone- and there was no one…": using Burden of Treatment Theory to understand the impact of a novel ATMP on early recipients. Orphanet J Rare Dis 2023; 18:86. [PMID: 37069697 PMCID: PMC10111696 DOI: 10.1186/s13023-023-02680-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 04/02/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Advanced therapy medicinal products such as Chimeric antigen receptor T-cell therapy offer ground-breaking opportunities for the treatment of various cancers, inherited diseases, and chronic conditions. With development of these novel therapies continuing to increase it's important to learn from the experiences of patients who were among the first recipients of ATMPs. In this way we can improve the clinical and psychosocial support offered to early patient recipients in the future to support the successful completion of treatments and trials. STUDY DESIGN We conducted a qualitative investigation informed by the principles of the key informant technique to capture the experience of some of the first patients to experience CAR-T therapy in the UK. A directed content analysis was used to populate a theoretical framework informed by Burden of Treatment Theory to determine the lessons that can be learnt in supporting their care, support, and ongoing self-management. RESULTS A total of five key informants were interviewed. Their experiences were described within the three domains of the burden of treatment framework; (1) The health care tasks delegated to patients, Participants described the frequency of follow-up and the resources involved, the esoteric nature of the information provided by clinicians; (2) Exacerbating factors of the treatment, which notably included the lack of understanding of the clinical impacts of the treatment in the broader health service, and the lack of a peer network to support patient understanding; (3) Consequences of the treatment, in which they described the anxiety induced by the process surrounding their selection for treatment, and the feeling of loneliness and isolation at being amongst the very first recipients. CONCLUSIONS If ATMPs are to be successfully introduced at the rates forecast, then it is important that the burden placed on early recipients is minimised. We have discovered how they can feel emotionally isolated, clinically vulnerable, and structurally unsupported by a disparate and pressured health service. We recommend that where possible, structured peer support be put in place alongside signposting to additional information that includes the planned pattern of follow-up, and the management of discharged patients would ideally accommodate individual circumstances and preferences to minimize the burden of treatment.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Melanie J Calvert
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- Applied Research Collaboration (ARC) - West Midlands, Birmingham, UK
- Birmingham Health Partners (BHP) Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Francesca Kinsella
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nisha Sungum
- Midlands and Wales Advanced Therapy Treatment Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Olalekan L Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- Applied Research Collaboration (ARC) - West Midlands, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Birmingham Health Partners (BHP) Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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Lyles CR, Nguyen OK, Khoong EC, Aguilera A, Sarkar U. Multilevel Determinants of Digital Health Equity: A Literature Synthesis to Advance the Field. Annu Rev Public Health 2023; 44:383-405. [PMID: 36525960 PMCID: PMC10329412 DOI: 10.1146/annurev-publhealth-071521-023913] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Current digital health approaches have not engaged diverse end users or reduced health or health care inequities, despite their promise to deliver more tailored and personalized support to individuals at the right time and the right place. To achieve digital health equity, we must refocus our attention on the current state of digital health uptake and use across the policy, system, community, individual, and intervention levels. We focus here on (a) outlining a multilevel framework underlying digital health equity; (b) summarizingfive types of interventions/programs (with example studies) that hold promise for advancing digital health equity; and (c) recommending future steps for improving policy, practice, and research in this space.
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Affiliation(s)
- Courtney R Lyles
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Public Health, University of California-Berkeley, Berkeley, California, USA
| | - Oanh Kieu Nguyen
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- Department of Medicine, Division of Hospital Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Elaine C Khoong
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
| | - Adrian Aguilera
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Social Welfare, University of California-Berkeley, Berkeley, California, USA
- Department of Psychiatry, University of California-San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
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10
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Qian Y, Emmerling DA, Kowitt SD, Ayala GX, Cherrington AL, Heisler M, Safford MM, Tang TS, Thom DH, Fisher EB. Diabetes distress mediates the relationship between depressive symptoms and glycaemic control among adults with type 2 diabetes: Findings from a multi-site diabetes peer support intervention. Diabet Med 2023:e15065. [PMID: 36762953 DOI: 10.1111/dme.15065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
AIMS Diabetes distress is positively associated with HbA1c and may mediate the relationship between depressive symptoms and HbA1c . This study examined these relationships in a geographically, socioeconomically, and ethnically diverse sample of adults with type 2 diabetes. METHODS Using data from five US sites evaluating peer support for diabetes management (n = 917), Structural Equation Modeling (SEM) examined whether diabetes distress (four items from Diabetes Distress Scale) mediated the relationship between depressive symptoms (PHQ-8) and HbA1c . Sites compared interventions of varying content and duration with control conditions. Time from Baseline Assessment to Final Assessment varied from six to 18 months. Site characteristics were controlled by entering site as a covariate along with age, sex, education, diabetes duration, insulin use, and intervention/control assignment. RESULTS Depressive symptoms, diabetes distress, and HbA1c were all intercorrelated cross-sectionally and from Baseline to Final Assessment (rs from 0.10 to 0.57; ps <0.05). In SEM analyses, diabetes distress at Final Assessment mediated the relationship between Baseline depressive symptoms and HbA1c at Final Assessment (indirect effect: b = 0.031, p < 0.001), controlling for Baseline HbA1c and covariates. Parallel analysis of whether depressive symptoms mediated the relationship between Baseline diabetes distress and HbA1c at Final Assessment was not significant. CONCLUSIONS In this diverse sample, diabetes distress mediated the influence of depressive symptoms on HbA1c but the reverse, depressive symptoms mediating the effect of distress, was not found. These findings add to the evidence that diabetes distress is a worthy intervention target to improve clinical status and quality of life among individuals with type 2 diabetes.
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Affiliation(s)
- Yiqing Qian
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Peers for Progress, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, Chapel Hill, USA
| | - Dane A Emmerling
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah D Kowitt
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Guadalupe X Ayala
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Andrea L Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michele Heisler
- VA Center for Clinical Management Research, Department of Health Behavior and Health Education, University of Michigan School of Public Health, and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Monika M Safford
- Department of Medicine, Weill Medical College of Cornell University, New York, New York, USA
| | - Tricia S Tang
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - David H Thom
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Edwin B Fisher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Peers for Progress, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, Chapel Hill, USA
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11
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Fisher EB. The Weltanschauung of Howard Rachlin: Interdependencies among behaviors and contexts. J Exp Anal Behav 2023; 119:259-271. [PMID: 36579737 DOI: 10.1002/jeab.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 12/30/2022]
Abstract
Through his broad perspectives and curiosity, Howard Rachlin took behaviorism, added critical perspectives and behavioral economics, and contributed substantially to developing behaviorism as an approach to addressing complex human actions and engagements. This essay describes the influence of Rachlin's work in three areas that reflect this broader growth of the field: 1) teleological behaviorism as a response to essentialist thinking about behavior, typified by Ryle's category mistake and including concepts in psychopathology; 2) self-control as choices among rewards differing by amount and delay and the application of this model to clinical and preventive interventions; and 3) behavioral economic modeling of social support as a commodity substitutable for other commodities of interest such as nicotine. These and the body of Rachlin's work suggest a view not only of interdependencies among behaviors, patterns of behavior, and their consequences, but more broadly, of interdependencies among different settings and their effects on behavior, leading to a behaviorism of systems and contexts. Replacing essentialist discourse of individuals, individual behaviors, and discrete influences, a world view or Weltanschauung emerges of diffuse interdependencies across patterns, individuals, settings, systems, probabilities, and consequences.
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Affiliation(s)
- Edwin B Fisher
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina Chapel Hill, 135 Dauer Drive, Chapel Hill, NC
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12
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Bossard C, Chihana M, Nicholas S, Mauambeta D, Weinstein D, Conan N, Nicco E, Suzi J, OConnell L, Poulet E, Ellman T. HIV, sexual violence, and termination of pregnancy among adolescent and adult female sex workers in Malawi: A respondent-driven sampling study. PLoS One 2022; 17:e0279692. [PMID: 36584132 PMCID: PMC9803093 DOI: 10.1371/journal.pone.0279692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022] Open
Abstract
Female Sex Workers (FSWs) are a hard-to-reach and understudied population, especially those who begin selling sex at a young age. In one of the most economically disadvantaged regions in Malawi, a large population of women is engaged in sex work surrounding predominantly male work sites and transport routes. A cross-sectional study in February and April 2019 in Nsanje district used respondent driven sampling (RDS) to recruit women ≥13 years who had sexual intercourse (with someone other than their main partner) in exchange for money or goods in the last 30 days. A standardized questionnaire was filled in; HIV, syphilis, gonorrhea, and chlamydia tests were performed. CD4 count and viral load (VL) testing occurred for persons living with HIV (PLHIV). Among 363 study participants, one-quarter were adolescents 13-19 years (25.9%; n = 85). HIV prevalence was 52.6% [47.3-57.6] and increased with age: from 14.7% (13-19 years) to 87.9% (≥35 years). HIV status awareness was 95.2% [91.3-97.4], ART coverage was 98.8% [95.3-99.7], and VL suppression 83.2% [77.1-88.0], though adolescent FSWs were less likely to be virally suppressed than adults (62.8% vs. 84.4%). Overall syphilis prevalence was 29.7% [25.3-43.5], gonorrhea 9.5% [6.9-12.9], and chlamydia 12.5% [9.3-16.6]. 72.4% had at least one unwanted pregnancy, 17.9% had at least one abortion (40.1% of which were unsafe). Half of participants reported experiencing sexual violence (SV) (47.6% [42.5-52.7]) and more than one-tenth (14.2%) of all respondents experienced SV perpetrated by a police officer. Our findings show high levels of PLHIV-FSWs engaged in all stages of the HIV cascade of care. The prevalence of HIV, other STIs, unwanted pregnancy, unsafe abortion, and sexual violence remains extremely high. Peer-led approaches contributed to levels of ART coverage and HIV status awareness similar to those found in the general district population, despite the challenges and risks faced by FSWs.
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Affiliation(s)
- Claire Bossard
- Epicentre, Médecins Sans Frontières, Paris, France
- * E-mail:
| | | | | | | | | | | | - Elena Nicco
- OCB, Médecins Sans Frontières, Blantyre, Malawi
| | - Joel Suzi
- The Malawi National Aids Commission, Lilongwe, Malawi
| | - Lucy OConnell
- Southern African Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | | | - Tom Ellman
- Southern African Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
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13
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Tawse J, Demou E. Qualitative study to explore UK medical students' and junior doctors' experiences of occupational stress and mental health during the COVID-19 pandemic. BMJ Open 2022; 12:e065639. [PMID: 36523252 PMCID: PMC9748513 DOI: 10.1136/bmjopen-2022-065639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This qualitative study aimed to explore the occupational experiences of medical students and junior doctors working during the COVID-19 pandemic. In particular, the research sought to identify factors which mediated work stress, barriers to disclosing mental health problems and levels of support medical students and junior doctors received during the pandemic. DESIGN This study was a form of thematic analysis and adopted an inductive, 'bottom-up' approach, in which coded categories were derived from rich, descriptive data. SETTING Semistructured interviews were conducted online with UK-based medical students and junior doctors. Interviews were recorded, and analysis was done by coding salient quotes into themes. PARTICIPANTS The final sample consisted of seven junior doctors and eight medical students, during the summer of 2021. RESULTS High levels of occupational stress were identified, which were exacerbated by COVID-19. A number of organisational difficulties associated with the pandemic compounded participants' experiences of work stress. Participants recognised progress towards promoting and managing mental health within the profession but may still be reluctant to access support services. Barriers to disclosure included fear of stigmatisation, concerns about adding to colleagues' workloads, lack of clarity about career implications and mistrust of occupational health services. CONCLUSIONS While attitudes towards mental health have improved, medical students and junior doctors may avoid seeking help. Given the immense pressures faced by health services, it is imperative that extra measures are implemented to minimise work-stress, encourage help-seeking behaviours and promote supportive work cultures.
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Affiliation(s)
- James Tawse
- University of Glasgow College of Social Sciences, Glasgow, UK
- Staff Advice and Liaison Service, Alder Hey Children's Hospital, Liverpool, UK
| | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
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14
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Pollock MD, Brotkin SM, Denio E, Dave S, Fisher EB, Docherty SL, Maslow GR. Clinical Application of a Peer Coaching Intervention to Enhance Self-Management for Adolescents and Young Adults With Inflammatory Bowel Disease. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2022; 10:409-427. [PMID: 37701558 PMCID: PMC10497228 DOI: 10.1037/cpp0000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Objective The purpose of this article is to characterize the current evidence base related to peer support interventions for adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) and to describe a peer support program to enhance self-management for AYAs with IBD through a case study. There is strong theory and compelling evidence suggesting that AYAs with IBD could benefit from and are interested in receiving peer support to enhance self-management; however, literature on peer support interventions for AYAs with IBD is lacking. Methods This study (a) presents a topical review describing qualitative factors AYAs with IBD would seek in a peer support program as well as existing peer support programs for this population, (b) presents an innovative one-to-one peer support program targeting self-management through a case study, and (c) discusses clinical implications and directions for future research. Results Peer support offers a promising approach for AYAs with IBD that is feasible and acceptable to patient populations. However, results from the present topical review identified only two studies that examined peer support interventions for AYAs with IBD. The case study demonstrates how a theoretically driven program uses peer support to promote self-management and adaptive behavioral change. Conclusions The paucity of literature in this area reveals a critical opportunity for future research and clinical programming to improve existing practices by leveraging peer support. We present the application of an innovative mobile-based peer coaching intervention that has the potential to support AYAs with IBD in their self-management.
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Affiliation(s)
- McLean D. Pollock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | | | - Erin Denio
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Sneha Dave
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Edwin B. Fisher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | | | - Gary R. Maslow
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
- Department of Pediatrics, Duke University School of Medicine
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15
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Valderrama A, Martinez A, Charlebois K, Guerrero L, Forgeot d'Arc B. For autistic persons by autistic persons: Acceptability of a structured peer support service according to key stakeholders. Health Expect 2022; 26:463-475. [PMID: 36447392 PMCID: PMC9854317 DOI: 10.1111/hex.13680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Social support is a protective factor in the mental health of autistic people. Furthermore, prejudice regarding autistic people is a constraint for the development of social support programmes by autistic peers. METHODS The objective of this study is to describe the anticipated acceptability of structured peer support programmes for and by autistic persons. Fifteen key stakeholders (six autistic adults, four caregivers and five service providers) participated in in-depth semistructured interviews. A qualitative thematic analysis of the content of the verbatim was carried out. FINDINGS We found that while a structured peer social support programme is acceptable to autistic people and caregivers, there was no consensus among service providers. The latter expressed doubts about the ability of autistic people to offer support. The framing of discussions between peers, the training of peer helpers, the support for autistic leadership and an organization that considers the communicational and sensory characteristics of autistic persons, could influence adherence to such a programme. Moreover, a space without service providers is an important condition for the acceptability of a peer support programme. CONCLUSION A structured peer support service for and by autistic persons could be an innovative way to answer the unmet support needs of autistic people. It seems essential to anticipate potential barriers and facilitators and to communicate among health professionals to promote this approach and reduce possible prejudice about the ability of autistic people to offer support to their peers. More studies are necessary. PATIENT OR PUBLIC CONTRIBUTION Fifteen key stakeholders who are involved in autistic people's trajectory of service and support participated in this research. We are a research team composed of healthcare professionals and researchers, in addition to one member of our team being an autistic advocate and a mental health peer-support mentor. Two members of our team are also parents of autistic children. The comprehensibility of the questions for the interview was consulted and discussed with one autistic advocate-collaborator.
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Affiliation(s)
- Alena Valderrama
- Department of Social and Preventive Medicine, School of Public HealthUniversité de MontréalMontréalQuebecCanada,Research Center of the Sainte‐Justine University HospitalMontréalQuebecCanada
| | - Alejandra Martinez
- Research Center of the Sainte‐Justine University HospitalMontréalQuebecCanada,Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuebecCanada
| | - Kathleen Charlebois
- Research Center of the Sainte‐Justine University HospitalMontréalQuebecCanada
| | - Lucila Guerrero
- Research Center of the Sainte‐Justine University HospitalMontréalQuebecCanada
| | - Baudouin Forgeot d'Arc
- Research Center of the Sainte‐Justine University HospitalMontréalQuebecCanada,Centre Intégré Universitaire de Santé et Services Sociaux de Nord‐de‐l'Île‐de‐MontréalMontréalQuebecCanada,Département de PsychiatrieUniversité de MontréalMontréalQuebecCanada
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16
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Khanna A, Dryden EM, Bolton RE, Wu J, Taylor SL, Clayman ML, Anwar C, Kasom D, McGowan M, Mullur RS, Bokhour BG, Hyde J. Promoting Whole Health and Well-Being at Home: Veteran and Provider Perspectives on the Impact of Tele-Whole Health Services. Glob Adv Health Med 2022; 11:2164957X221142608. [PMID: 36452292 PMCID: PMC9703484 DOI: 10.1177/2164957x221142608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background The Veterans Health Administration (VA) is undergoing a transformation in how healthcare is organized and provided. This transformation to a Whole Health System of Care encompasses the integration of complementary and integrative health services, education, and Whole Health coaching to develop Veterans' self-care skills. During the COVID-19 pandemic, these services were provided via telehealth (tele-WH). Objective We sought to understand Veteran and provider perspectives on how tele-WH impacts Veteran engagement in Whole Health-aligned services and the impact on their well-being. Methods Semi-structured interviews were conducted with 51 providers who delivered tele-WH at 10 VA Medical Centers (VAMCs) and 19 Veterans receiving tele-WH at 6 VAMCs. Participants were asked about their experiences with tele-WH, what they perceived to be the impact of tele-WH on Veterans, and their preferences moving forward. Interviews were transcribed, and a content analysis was performed using a rapid approach. Results We identified 3 major themes that describe the perceived impact of tele-WH on Veterans. These include: (1) increased use of Whole Health-aligned services; (2) deeper engagement with Whole-Health aligned services; and (3) improvements in social, psychological, and physical well-being. Conclusion Tele-WH is perceived to be a strong complement to in-person services and is a promising mechanism for improving engagement with Whole Health-aligned services and promoting Veteran well-being. Future research is needed to measure outcomes identified in this study and to support more equitable access to telehealth for all.
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Affiliation(s)
- Aishwarya Khanna
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Eileen M. Dryden
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Rendelle E. Bolton
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Brandeis University, The Heller School for Social Policy and Management, MA, USA
| | - Juliet Wu
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Stephanie L. Taylor
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
- University of California Los Angeles, David Geffen School of Medicine, Department of Medicine School of Public Health, Department of Health Policy and Management, Los Angeles, CA, USA
| | - Marla L. Clayman
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, 368 Plantation Street Worcester, MA 01605
| | - Chitra Anwar
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Danna Kasom
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
| | - Michael McGowan
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
| | - Rashmi S. Mullur
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
- Division of Diabetes, Endocrinology & Metabolism, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Integrative Medicine Collaborative, University of California Los Angeles Health, Los Angeles, CA, USA
| | - Barbara G. Bokhour
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, 368 Plantation Street Worcester, MA 01605
| | - Justeen Hyde
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Boston University School of Medicine, Section of General Internal Medicine, Department of Medicine, Boston, MA, USA
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17
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Green MM, Lowthian JA, Allgood H, Ogrin R. Volunteer peer support frameworks supporting older women living alone. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4252-e4263. [PMID: 35514274 PMCID: PMC10084035 DOI: 10.1111/hsc.13818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/31/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
Volunteer peer support is an approach that enables a supportive connection between volunteers and a sub-set of community members with shared experiences or interests. To implement co-designed strategies to support older women to maintain independence and optimise wellbeing in Australia, a volunteer peer support approach was proposed. There was limited literature describing volunteer peer support frameworks to underpin interventions of this kind; and given the increasing desire for engagement of individuals and communities, articulation of the key components of such a framework is warranted. In this paper, we define volunteers and peer support, and outline existing frameworks for volunteering and peer support. We then describe the volunteer peer support framework developed for this intervention, outlining the key requirements. This information will enable others to develop an effective and sustainable structure for peer support volunteer services.
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Affiliation(s)
- Maja M. Green
- Bolton Clarke Research InstituteForest HillVictoriaAustralia
| | - Judy A. Lowthian
- Bolton Clarke Research InstituteForest HillVictoriaAustralia
- School of Public Health and Preventive Medicine at Monash UniversityMelbourneVictoriaAustralia
- Faculty of Health and Behavioural SciencesThe University of QueenslandBrisbaneQueenslandAustralia
| | | | - Rajna Ogrin
- Bolton Clarke Research InstituteForest HillVictoriaAustralia
- Department of Business Strategy and InnovationGriffith UniversityGold CoastAustralia
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18
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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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19
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McLardie-Hore FE, Forster DA, Shafiei T, McLachlan HL. First-time mothers' experiences of receiving proactive telephone-based peer support for breastfeeding in Australia: a qualitative study. Int Breastfeed J 2022; 17:31. [PMID: 35459252 PMCID: PMC9034489 DOI: 10.1186/s13006-022-00476-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 04/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background The RUBY randomised controlled trial was found to be effective in promoting breastfeeding continuation, in the setting of a high income country, through a program of proactive telephone-based peer support in the first 6 months postpartum. This paper explores women’s experiences of receiving the peer support intervention in the RUBY trial. Methods Ten in-depth, face-to-face interviews were conducted between December 2015 and November 2016 in Metropolitan Melbourne, and regional Victoria, Australia. Participants were women who received the peer support intervention in the RUBY trial and were between 11 and 15 months postpartum at the time of interview. Interviews were underpinned by social support theories and were analysed using inductive thematic analysis. Results A global theme of ‘non-judgemental support and guidance’ was identified, which included five organising themes. Four of the organising themes centred on the support from the peer, in which women felt the support was a ‘positive experience with empathy and understanding’, ‘non-judgemental’, ‘practical advice’, and a ‘social connection that was more than just breastfeeding’. In contrast to the support from peers was the theme ‘not all support from family and friends is supportive’. Conclusion Participants, including those who considered that they had adequate and available family and friend support for breastfeeding, valued and appreciated the non-judgemental, empathetic and understanding support from peers. This support, facilitated by the anonymity of the telephone-based program, allowed open and honest conversations, normalising women’s experiences and helping them feel less alone in their challenges with breastfeeding and transition to motherhood. These findings can inform the design, and upscaling, of innovative and sustainable peer support models, ensuring delivery of effective and engaging support with a broad population reach.
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Affiliation(s)
- Fiona E McLardie-Hore
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia. .,Royal Women's Hospital, Melbourne, VIC, Australia.
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.,Royal Women's Hospital, Melbourne, VIC, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.,School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
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Peers empowering peers-feasibility of a peer educator training program to prevent diabetes. BMC Womens Health 2022; 22:65. [PMID: 35260142 PMCID: PMC8905906 DOI: 10.1186/s12905-022-01645-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/01/2022] [Indexed: 11/11/2022] Open
Abstract
Background This study assessed the feasibility and acceptability of the Healthy Outcomes through Peer Educators (HOPE) training program designed to train African American (AA) grandmothers to serve as peer educators for other AA grandmothers who are at risk for diabetes. The newly trained peer educators will provide the needed encouragement and positive reinforcement essential for successful sustainable health behaviors to grandmothers enrolled in a subsequent Diabetes Prevention Program. Methods Thirty AA women between the ages of 49–72 were enrolled in the pre-post single group study. The participants were required to attend a 2-h Diabetes Prevention Program session every week for 16 weeks. The sessions covered the role of the peer educator and encouraged participants to increase their physical activity and consume more servings of fruits and vegetables daily. We noted the number of participants who successfully completed the training and solicited their perspective regarding the strengths of the program and suggestions to improve the program. The Wilcoxon Signed Ranks Test was performed to evaluate changes in body weight, self-reported physical activity, and fruit and vegetable intake from baseline to week 16. Results Ninety three percent (n = 28) of enrollees completed the training program. All (n = 28) the peer educator trainees indicated that they would recommend the program to a friend and 93% (n = 26) reported that the program met their needs. The participants (n = 28) felt that the training prepared them to offer support to other grandmothers in their community. A Wilcoxon Signed Ranks Test revealed that participants body weights were significantly lower after completion of the 16 week training program (median = 156.5 lbs., n = 28) compared to baseline (median = 163.0, n = 28), Z = − 4.43, p < 0.05. Fruit and vegetable intake increased significantly (median = 5, n = 28) at week 16 compared to week one, (median = 2, n = 28) Z = 4.46, p < 0.05. Participants were more physically active at week 16 (median = 150 min per week, n = 28) compared to week 1, (median = 30 min per week, n = 28) Z = 4.62, p < 0.05. Conclusions The peer educator training component of HOPE was found to be feasible and acceptable as evidenced by our successful recruitment and retention of participants. Participation in the peer educator training program also resulted in improvement in health behaviors.
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Golestaneh L, Melamed M, Kim RS, St. Clair Russell J, Heisler M, Villalba L, Perry T, Cavanaugh KL. Peer mentorship to improve outcomes in patients on hemodialysis (PEER-HD): a randomized controlled trial protocol. BMC Nephrol 2022; 23:92. [PMID: 35247960 PMCID: PMC8897762 DOI: 10.1186/s12882-022-02701-1] [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: 01/20/2022] [Accepted: 02/12/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patients receiving in-center hemodialysis experience disproportionate morbidity and incur high healthcare-related costs. Much of this cost stems from potentially avoidable hospitalizations. Peer mentorship has been used effectively to improve outcomes for patients with complex chronic diseases. We propose testing the efficacy of peer mentorship on hospitalization rates among patients receiving hemodialysis.
Methods
This is a multicenter parallel group randomized controlled pragmatic trial of patients treated at hemodialysis facilities in Bronx, NY and Nashville, TN. The study has two phases. Phase 1 will enroll and train 16 hemodialysis patients (10 in Bronx, NY and 6 in Nashville TN) to be mentors using a program focused on enhancing self-efficacy, dialysis self-management and autonomy-supportive communication skills. Phase 2 will enroll 200 high risk adults receiving hemodialysis (140 in Bronx, NY and 60 in Nashville, TN), half of whom will be randomized to intervention and half to usual care. Intervention participants are assigned to weekly telephone calls with trained mentors (see Phase 1) for a 3-month period.
The primary outcome of Phase 1 will be engagement of mentors with training and change in knowledge scores and autonomy skills from pre- to post-training. The primary outcome of Phase 2 will be the composite count of ED visits and hospitalizations at the end of study follow-up in patient participants assigned to intervention as compared to those assigned to usual care. Secondary outcomes for Phase 2 include the change over the trial period in validated survey scores measuring perception of social support and self-efficacy, and dialysis adherence metrics, among intervention participants as compared to usual care participants.
Discussion
The PEER-HD study will test the feasibility and efficacy of a pragmatic peer-mentorship program designed for patients receiving hemodialysis on ED visit and hospitalization rates. If effective, peer-mentorship holds promise as a scalable patient-centered intervention to decrease hospital resource utilization, and by extension morbidity and cost, for patients receiving maintenance in-center hemodialysis.
Trial registration
Clinicaltrials.gov identifier: NCT03595748; 7/23/2018.
Trial sponsor
National Institutes of Diabetes, Digestive and Kidney Disease (NIDDK) 5R18DK118471.
Funding
Funding for this study was provided by the National Institutes of Diabetes, Digestive and Kidney Disease: R18DK118471.
Study status
This is an ongoing study and not complete. We are still collecting data for observational follow-up on participants.
Related articles
No related articles for this study have been submitted to any journal.
The study sponsor and funders had no role in the design, analysis or interpretation of this data. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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White Perkins D, Milan P, Miazek K, Havstad S, Wegienka G. Identifying factors affecting diabetes education program participation within a metro Detroit integrated health system. Prev Med Rep 2021; 24:101646. [PMID: 34976695 PMCID: PMC8683990 DOI: 10.1016/j.pmedr.2021.101646] [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: 05/04/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Classification and regression tree analysis identified patterns in participation. White people, >43 years old, with A1c > 8.9 and with Medicaid had lowest contact. People with Medicaid, <48 years, and A1C > 8.1 had lowest intake session attendance. Older males with A1c ≤ 8.3% had the highest rate (66.0%) of completing their plan.
Diabetes self-management education and support (DSMES) can help people achieve optimal disease control, yet these services often remain underutilized. People referred to these programs by their provider can become disengaged in the program at several key steps. This study applies Classification and Regression Tree analysis to 3796 people with diabetes at a single health system based in the Detroit metropolitan area who were referred for DSMES provided by the health system to determine demographic patterns of those who were successfully contacted to schedule program intake appointments, those who did not attend their intake appointment, and those who began but did not complete their personalized DSMES program. White people > 43 years of age, those with a prior A1C value > 8.9 and those with Medicaid insurance had the highest rate of not being successfully contacted for their intake appointment. Those who did not attend their intake appointment tended to have Medicaid insurance, be younger than 48 years, and have A1C > 8.1. Within the Medicare or private insurance groups, those who did not attend were more likely to be female, of Black race and not partnered. Older males with a lower A1C (≤8.3%) had the lowest rate (34.0%) of failing to complete their DSMES plan. The data showed that almost half of those referred were not successfully contacted. The overall low completion rate of 13.2% confirms the need to examine factors predictive of participation and completion. This study highlights process improvement changes to improve personalization of outreach and engagement.
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Affiliation(s)
- Denise White Perkins
- Department of Family Medicine, Henry Ford Health System, One Ford Place, Detroit, MI 48202, USA
- Corresponding author at: One Ford Place, 3E, Detroit, MI 48202, USA.
| | - Pam Milan
- Department of Population Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI 48202, USA
| | - Kimberly Miazek
- Department of Population Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI 48202, USA
| | - Suzanne Havstad
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI 48202, USA
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI 48202, USA
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Carreon SA, Duran B, Tang TS, Streisand R, Anderson BJ, Lyons SK, McKay S, Hilliard ME. Here for You: A Review of Social Support Research in Young Adults With Diabetes. Diabetes Spectr 2021; 34:363-370. [PMID: 34866869 PMCID: PMC8603130 DOI: 10.2337/dsi21-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Living with and managing diabetes is challenging during young adulthood, and social support may help relieve or minimize the burdens young adults with diabetes experience. This article reviews the types and sources of support young adults with diabetes receive and their associations with behavioral, psychosocial, and glycemic outcomes. Intervention research integrating social support and future directions for care are discussed.
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Affiliation(s)
| | - Brenda Duran
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Tricia S. Tang
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Randi Streisand
- Children’s National Hospital, Washington, DC
- George Washington University School of Medicine, Washington, DC
| | | | - Sarah K. Lyons
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Siripoom McKay
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Marisa E. Hilliard
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
- Corresponding author: Marisa E. Hilliard,
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Chepkirui D, Nzinga J, Jemutai J, Tsofa B, Jones C, Mwangome M. A scoping review of breastfeeding peer support models applied in hospital settings. Int Breastfeed J 2020; 15:95. [PMID: 33189155 PMCID: PMC7666507 DOI: 10.1186/s13006-020-00331-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 10/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The 2013 updated guidelines on management of severe acute malnutrition in infants and children recommends the support of exclusive breastfeeding. These guidelines are inconsistently applied in low and middle income countries (LMICs) due to barriers including unclear implementation guides, technical support and epidemiological factors. Peer support strategies have been used to offer psychological support to families with infants in NICU and improve mental health outcomes. Breastfeeding peer supporters (BFPS) have been shown to be effective in improving breastfeeding outcomes in community settings however, their success within hospital settings in LMICs is unknown. We conducted a scoping review to explore implementation of breastfeeding peer support strategies as have been applied to hospitalized infants globally and highlight their implementation strategies in order to guide future research and practice. METHODS A scoping review of the literature was conducted using the Arksey and O'Malley framework. A search was conducted in five online databases (PubMed, Cochrane library, Hinari, Google Scholar and Open Grey library). Data were extracted and charted in data extraction tables to capture general characteristics, modes of peer support delivery, implementation details and evaluation procedures. RESULTS From the online search 276 articles were identified, however only 18 met the inclusion criteria for the study. The majority of these articles were reports on in-patient breastfeeding peer support interventions applied in Europe and the United States of America and only two were from LMICs. The articles described peer supporters' identification, training (n = 13) and supervision (n = 14). The majority of the BFPS were employed (n = 10) compared to volunteers (n = 3) and support was mainly one-to-one (n = 11) rather than group support. Process and impact evaluation (n = 13) reported positive breastfeeding outcomes associated with breastfeeding peer support. CONCLUSION Breastfeeding peer support strategies are applied in different hospital settings and can be used to improve breastfeeding outcomes. However, to achieve integration, scalability and comparability of impact and outcomes, there is a need to standardize training, develop consistent implementation and supervision plans of in-patient peer supporters' strategies. Further research to assess sustainability and evaluate cost-effectiveness of in-patient breastfeeding peer support strategies will improve uptake and scalability of these potentially lifesaving interventions.
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Affiliation(s)
- Dorothy Chepkirui
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 230, Kilifi, 80108 Kenya
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya
| | - Jacinta Nzinga
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 230, Kilifi, 80108 Kenya
| | - Julie Jemutai
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 230, Kilifi, 80108 Kenya
| | - Benjamin Tsofa
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 230, Kilifi, 80108 Kenya
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya
| | - Caroline Jones
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 230, Kilifi, 80108 Kenya
- Centre for Tropical Medicine and Global health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ UK
| | - Martha Mwangome
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, P.O. Box 230, Kilifi, 80108 Kenya
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Heisler M, Kullgren J, Richardson C, Stoll S, Alvarado Nieves C, Wiley D, Sedgwick T, Adams A, Hedderson M, Kim E, Rao M, Schmittdiel JA. Study protocol: Using peer support to aid in prevention and treatment in prediabetes (UPSTART). Contemp Clin Trials 2020; 95:106048. [PMID: 32497783 PMCID: PMC8059966 DOI: 10.1016/j.cct.2020.106048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is an urgent need to develop and evaluate effective and scalable interventions to prevent or delay the onset of type 2 diabetes mellitus (T2DM). METHODS In this randomized controlled pragmatic trial, 296 adults with prediabetes will be randomized to either a peer support arm or enhanced usual care. Participants in the peer support arm meet face-to-face initially with a trained peer coach who also is a patient at the same health center to receive information on locally available wellness and diabetes prevention programs, discuss behavioral goals related to diabetes prevention, and develop an action plan for the next week to meet their goals. Over six months, peer coaches call their assigned participants weekly to provide support for weekly action steps. In the final 6 months, coaches call participants at least once monthly. Participants in the enhanced usual care arm receive information on local resources and periodic updates on available diabetes prevention programs and resources. Changes in A1c, weight, waist circumference and other patient-centered outcomes and mediators and moderators of intervention effects will be assessed. RESULTS At least 296 participants and approximately 75 peer supporters will be enrolled. DISCUSSION Despite evidence that healthy lifestyle interventions can improve health behaviors and reduce risk for T2DM, engagement in recommended behavior change is low. This is especially true among racial and ethnic minority and low-income adults. Regular outreach and ongoing support from a peer coach may help participants to initiate and sustain healthy behavior changes to reduce their risk of diabetes. TRIAL REGISTRATION The ClinicalTrials.gov registration number is NCT03689530.
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Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America.
| | - Jeffrey Kullgren
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States of America; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States of America.
| | - Caroline Richardson
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America.
| | - Shelley Stoll
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America.
| | - Cristina Alvarado Nieves
- University of Michigan, Department of Internal Medicine- Metabolism, Endocrinology and Diabetes, United States of America.
| | - Deanne Wiley
- Kaiser Permanente Northern California, United States of America.
| | - Tali Sedgwick
- Kaiser Permanente Northern California Division of Research, United States of America.
| | - Alyce Adams
- Kaiser Permanente Northern California, United States of America.
| | | | - Eileen Kim
- The Permanente Medical Group (Kaiser Permanente, Northern California), United States of America.
| | - Megan Rao
- The Permanente Medical Group (Kaiser Permanente, Northern California), United States of America.
| | - Julie A Schmittdiel
- Kaiser Permanente Northern California Division of Research, United States of America.
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Senteio CR, Akincigil A. Illuminating Racial Inequity in Diabetes Control: Differences Based on Gender and Geography. J Racial Ethn Health Disparities 2020; 8:704-711. [DOI: 10.1007/s40615-020-00830-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 06/25/2020] [Accepted: 07/23/2020] [Indexed: 01/19/2023]
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Shalaby RAH, Agyapong VIO. Peer Support in Mental Health: Literature Review. JMIR Ment Health 2020; 7:e15572. [PMID: 32357127 PMCID: PMC7312261 DOI: 10.2196/15572] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/06/2019] [Accepted: 02/15/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND A growing gap has emerged between people with mental illness and health care professionals, which in recent years has been successfully closed through the adoption of peer support services (PSSs). Peer support in mental health has been variously defined in the literature and is simply known as the help and support that people with lived experience of mental illness or a learning disability can give to one another. Although PSSs date back to several centuries, it is only in the last few decades that these services have formally evolved, grown, and become an integral part of the health care system. Debates around peer support in mental health have been raised frequently in the literature. Although many authors have emphasized the utmost importance of incorporating peer support into the health care system to instill hope; to improve engagement, quality of life, self-confidence, and integrity; and to reduce the burden on the health care system, other studies suggest that there are neutral effects from integrating PSSs into health care systems, with a probable waste of resources. OBJECTIVE In this general review, we aimed to examine the literature, exploring the evolution, growth, types, function, generating tools, evaluation, challenges, and the effect of PSSs in the field of mental health and addiction. In addition, we aimed to describe PSSs in different, nonexhaustive contexts, as shown in the literature, that aims to draw attention to the proposed values of PSSs in such fields. METHODS The review was conducted through a general search of the literature on MEDLINE, Google Scholar, EMBASE, Scopus, Chemical Abstracts, and PsycINFO. Search terms included peer support, peer support in mental health, social support, peer, family support, and integrated care. RESULTS There is abundant literature defining and describing PSSs in different contexts as well as tracking their origins. Two main transformational concepts have been described, namely, intentional peer support and transformation from patients to peer support providers. The effects of PSSs are extensive and integrated into different fields, such as forensic PSSs, addiction, and mental health, and in different age groups and mental health condition severity. Satisfaction of and challenges to PSS integration have been clearly dependent on a number of factors and consequently impact the future prospect of this workforce. CONCLUSIONS There is an internationally growing trend to adopt PSSs within addiction and mental health services, and despite the ongoing challenges, large sections of the current literature support the inclusion of peer support workers in the mental health care workforce. The feasibility and maintenance of a robust PSS in health care would only be possible through collaborative efforts and ongoing support and engagement from all health care practitioners, managers, and other stakeholders.
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Akena D, Okello ES, Simoni J, Wagner G. The development and tailoring of a peer support program for patients with diabetes mellitus and depression in a primary health care setting in Central Uganda. BMC Health Serv Res 2020; 20:436. [PMID: 32430046 PMCID: PMC7236139 DOI: 10.1186/s12913-020-05301-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/06/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND About 20-40% of patients with diabetes mellitus (DM) suffer from depressive disorders (DD) during the course of their illness. Despite the high burden of DD among patients with DM, it is rarely identified and adequately treated at the majority of primary health care clinics in sub-Saharan Africa (SSA). The use of peer support to deliver components of mental health care have been suggested in resource constrained SSA, even though its acceptability have not been fully examined. METHODS We conducted qualitative interviews (QI) to assess the perceptions of DM patients with an experience of suffering from a DD about the acceptability of delivering peer support to patients with comorbid DM and DD. We then trained them to deliver peer support to DM patients who were newly diagnosed with DD. We identified challenges and potential barriers to a successful implementation of peer support, and generated solutions to these barriers. RESULTS Participants reported that for one to be a peer, they need to be mature in age, consistently attend the clinics/keep appointments, and not to be suffering from any active physical or co-morbid mental or substance abuse disorder. Participants anticipated that the major barrier to the delivery of peer support would be high attrition rates as a result of the difficulty by DM patients in accessing the health care facility due to financial constraints. A potential solution to this barrier was having peer support sessions coinciding with the return date to hospital. Peers reported that the content of the intervention should mainly be about the fact that DM was a chronic medical condition for which there was need to adhere to lifelong treatment. There was consensus that peer support would be acceptable to the patients. CONCLUSION Our study indicates that a peer support program is an acceptable means of delivering adjunct care to support treatment adherence and management, especially in settings where there are severe staff shortages and psycho-education may not be routinely delivered.
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Affiliation(s)
- Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elialilia S. Okello
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
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Salimu S, Kinshella MLW, Vidler M, Banda M, Newberry L, Dube Q, Molyneux EM, Goldfarb DM, Kawaza K, Nyondo-Mipando AL. Health workers' views on factors affecting caregiver engagement with bubble CPAP. BMC Pediatr 2020; 20:180. [PMID: 32326900 PMCID: PMC7179004 DOI: 10.1186/s12887-020-02088-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Severe respiratory distress is a leading cause of mortality among neonates in Malawi. Despite evidence on the safety, cost effectiveness and efficacy of bubble continuous positive airway pressure (CPAP) in managing the condition, its use in Malawian health facilities is limited and little is known about caregivers’ engagement with perspectives of bubble CPAP. The purpose of this study was to explore caregiver perspectives for bubble CPAP at both central and district hospitals and key factors that enable effective caregiver engagement in Malawi. Methods This was a descriptive qualitative study employing secondary analysis of 46 health care worker in-depth interviews. We interviewed the health workers about their thoughts on caregiver perspectives regarding use of bubble CPAP. We implemented the study at a tertiary facility and three district hospitals in southern Malawi. This was a part of a larger study to understand barriers and facilitators to implementing neonatal innovations in resource-constrained hospitals. Interviews were thematically analysed in NVivo 12 software (QSR International, Melbourne, Australia). Health workers were purposively selected to include nurses, clinicians and district health management involved in the use of bubble CPAP. Results Emerging issues included caregiver fears around bubble CPAP equipment as potentially harmful to their new-borns and how inadequate information provided to caregivers exacerbated knowledge gaps and was associated with refusal of care. However, good communication between health care providers and caregivers was associated with acceptance of care. Caregivers’ decision-making was influenced by relatives and peer advocates were helpful in supporting caregivers and alleviating fears or misconceptions about bubble CPAP. Conclusions Since caregivers turn to relatives and peers for support, there is need to ensure that both relatives and peers are counselled on bubble CPAP for improved understanding and uptake. Health workers need to provide simplified, accurate, up-to-date information on the intervention as per caregivers’ level of understanding. Notably, contextualised comprehensible information will help alleviate caregivers’ fear and anxieties about bubble CPAP.
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Affiliation(s)
- Sangwani Salimu
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
| | - Mwai Banda
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Laura Newberry
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Queen Dube
- Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - Elizabeth M Molyneux
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
| | - Kondwani Kawaza
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - Alinane Linda Nyondo-Mipando
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.,School of Public Health and Family Medicine, Department of Health Systems and Policy, College of Medicine, University of Malawi, Blantyre, Malawi
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Mahadzir MDA, Quek KF, Ramadas A. Process Evaluation of a Nutrition and Lifestyle Behavior Peer Support Program for Adults with Metabolic Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082641. [PMID: 32290570 PMCID: PMC7215631 DOI: 10.3390/ijerph17082641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 01/02/2023]
Abstract
Metabolic Syndrome (MetS) is a cluster of risk factors that increases the risk for diabetes and cardiovascular diseases. Lifestyle intervention is the gold standard of MetS management and prevention. Despite the growing positive influence of peer support-based interventions on management of various chronic diseases, its potential among adults with MetS has not been elucidated. We describe the development and process evaluation of a nutrition and lifestyle behavior “PEeR SUpport program for ADults with mEtabolic syndrome” (PERSUADE) using a systematic five-step approach—(i) review of evidence; (ii) focus group discussions; (iii) behavioral matrix development; (iv) module development; and (v) feasibility and process evaluation. High program adherence was recorded with 81.3% of participants attending all peer sessions. Participants’ content satisfaction score was high (93.3%) while peer leadership score was satisfactory (70.0%). There were significant reductions in all anthropometric and metabolic parameters assessed post intervention, except for diastolic blood pressure. Significant correlations were found between reductions in body fat and triglyceride, and content satisfaction. Peer leadership was only significantly correlated with reduction in triglyceride. Future studies can explore aspects of module interactivity, use of social media, and other means to stimulate consistent engagement of participants, as well as extending the implementations to other lifestyle-related diseases.
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Affiliation(s)
| | | | - Amutha Ramadas
- Correspondence: (M.D.A.M.); (A.R.); Tel.: +60-1-2512-2567 (M.D.A.M.); +60-3-5515-9660 (A.R.)
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Jull J, Hizaka A, Sheppard AJ, Kewayosh A, Doering P, MacLeod L, Joudain G, Plourde J, Dorschner D, Rand M, Habash M, Graham ID. An integrated knowledge translation approach to develop a shared decision-making strategy for use by Inuit in cancer care: a qualitative study. Curr Oncol 2019; 26:192-204. [PMID: 31285666 PMCID: PMC6588049 DOI: 10.3747/co.26.4729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background In relation to the general Canadian population, Inuit face increased cancer risks and barriers to health services use. In shared decision-making (sdm), health care providers and patients make health care decisions together. Enhanced participation in cancer care decisions is a need for Inuit. Integrated knowledge translation (kt) supports the development of research evidence that is likely to be patient-centred and applied in practice. Objective Using an integrated kt approach, we set out to promote the use of sdm by Inuit in cancer care. Methods An integrated kt study involving researchers with a Steering Committee of cancer care system partners who support Inuit in cancer care ("the team") consisted of 2 theory-driven phases:■ using consensus-building methods to tailor a previously developed sdm strategy and developing training in the sdm strategy; and■ training community support workers (csws) in the sdm strategy and testing the sdm strategy with community members. Results The team developed a sdm strategy that included a workshop and a booklet with 6 questions for use by csws with patients. The sdm strategy (training and booklet) was finalized based on feedback from 5 urban-based Inuit csws who were recruited and trained in using the strategy. Trained csws were matched with 8 community members, and use of the sdm strategy was assessed during interviews, reported as 6 themes. Participants found the sdm strategy to be useful and feasible for use. Conclusions An integrated kt approach of structured research processes with partners developed a sdm strategy for use by Inuit in cancer care. Further work is needed to test the sdm strategy.
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Affiliation(s)
- J Jull
- School of Rehabilitation Therapy, Queen's University, Kingston, ON
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - A Hizaka
- Tungasuvvingat Inuit, Ottawa, ON
| | - A J Sheppard
- Indigenous Cancer Control Unit, Cancer Care Ontario, Toronto, ON
| | - A Kewayosh
- Indigenous Cancer Control Unit, Cancer Care Ontario, Toronto, ON
| | | | | | - G Joudain
- Ottawa Health Services Network Inc., Ottawa, ON
| | - J Plourde
- Ottawa Health Services Network Inc., Ottawa, ON
| | - D Dorschner
- Ottawa Health Services Network Inc., Ottawa, ON
| | - M Rand
- Indigenous Cancer Control Unit, Cancer Care Ontario, Toronto, ON
| | - M Habash
- Indigenous Cancer Control Unit, Cancer Care Ontario, Toronto, ON
| | - I D Graham
- Epidemiology and Public Health, University of Ottawa, Ottawa, ON
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Cummings DM, Lutes LD, Littlewood K, Solar C, Carraway M, Kirian K, Patil S, Adams A, Ciszewski S, Edwards S, Gatlin P, Hambidge B. Randomized Trial of a Tailored Cognitive Behavioral Intervention in Type 2 Diabetes With Comorbid Depressive and/or Regimen-Related Distress Symptoms: 12-Month Outcomes From COMRADE. Diabetes Care 2019; 42:841-848. [PMID: 30833367 DOI: 10.2337/dc18-1841] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/04/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study evaluated the effect of cognitive behavioral therapy (CBT) plus lifestyle counseling in primary care on hemoglobin A1c (HbA1c) in rural adult patients with type 2 diabetes (T2D) and comorbid depressive or regimen-related distress (RRD) symptoms. RESEARCH DESIGN AND METHODS This study was a randomized controlled trial of a 16-session severity-tailored CBT plus lifestyle counseling intervention compared with usual care. Outcomes included changes in HbA1c, RRD, depressive symptoms, self-care behaviors, and medication adherence across 12 months. RESULTS Patients included 139 diverse, rural adults (mean age 52.6 ± 9.5 years; 72% black; BMI 37.0 ± 9.0 kg/m2) with T2D (mean HbA1c 9.6% [81 mmol/mol] ± 2.0%) and comorbid depressive or distress symptoms. Using intent-to-treat analyses, patients in the intervention experienced marginally significant improvements in HbA1c (-0.92 ± 1.81 vs. -0.31 ± 2.04; P = 0.06) compared with usual care. However, intervention patients experienced significantly greater improvements in RRD (-1.12 ± 1.05 vs. -0.31 ± 1.22; P = 0.001), depressive symptoms (-3.39 ± 5.00 vs. -0.90 ± 6.17; P = 0.01), self-care behaviors (1.10 ± 1.30 vs. 0.58 ± 1.45; P = 0.03), and medication adherence (1.00 ± 2.0 vs. 0.17 ± 1.0; P = 0.02) versus usual care. Improvement in HbA1c correlated with improvement in RRD (r = 0.3; P = 0.0001) and adherence (r = -0.23; P = 0.007). CONCLUSIONS Tailored CBT with lifestyle counseling improves behavioral outcomes and may improve HbA1c in rural patients with T2D and comorbid depressive and/or RRD symptoms.
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Affiliation(s)
- Doyle M Cummings
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC .,Center for Health Disparities, East Carolina University, Greenville, NC
| | - Lesley D Lutes
- Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada
| | | | - Chelsey Solar
- Department of Psychology, East Carolina University, Greenville, NC
| | - Marissa Carraway
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Kari Kirian
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Shivajirao Patil
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Alyssa Adams
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Stefanie Ciszewski
- Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada
| | - Sheila Edwards
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Peggy Gatlin
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Bertha Hambidge
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
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Mehdi Hazavehei SM, Khoshravesh S, Taheri-Kharameh Z. Increasing Medical Adherence in Elderly With Type 2 Diabetes Mellitus: A Systematic Review. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 39:109-117. [PMID: 30799762 DOI: 10.1177/0272684x18819969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND One of the most common problems that the elderly with chronic diseases, especially diabetes, faces is lack or poor medical adherence. The aim of this study was to determine the effect of interventions in increasing medical adherence in the elderly with type 2 diabetes. METHODS The databases of Cochrane, Embase, PubMed, Scopus, Science Direct, and web of science were searched until April 2017 free from time and language limitation. In review, only randomized controlled trial (RCT) design studies were investigated. The studies of interest were evaluated from three perspectives: educational intervention with or without theories/models of health education and promotion, educational intervention (individual or group education), and noneducational intervention to increase medical adherence. The qualification of RCTs was evaluated through Cochrane Collaboration Risk of Bias Tool. RESULTS Finally, five studies were considered in this systematic review. Educational interventions were used in all of the studies, and in three of these studies, noneducational interventions such as support group, psychiatric consultation, and phone consultation were implemented along with educational intervention. In all studies, medical adherence in the intervention group increased when compared with the control group or basic conditions ( p < .05). All RCTs had high risk of bias. CONCLUSION This review provides evidence which must be considered in the elderly with diabetes a combination of the educational and noneducational methods to increase medical adherence. It is necessary to conduct studies with higher quality to assess the efficacy of interventions.
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Affiliation(s)
| | - Sahar Khoshravesh
- 2 Students Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
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Shen Z, Zheng F, Zhong Z, Ding S, Wang L. Effect of peer support on health outcomes in patients with cardiac pacemaker implantation: A randomized, controlled trial. Nurs Health Sci 2019; 21:269-277. [PMID: 30677198 DOI: 10.1111/nhs.12595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 01/24/2023]
Abstract
The aim of this study was to examine the effect of a nurse-led telephone-based peer support program on health outcomes in patients after cardiac pacemaker implantation. Seventy six patients who received cardiac pacemaker implantation were recruited as participants and randomly assigned to either the peer support group or the usual care group. The usual care group received routine care and health education measures provided by nurses; the peer support group received telephone-based peer support. Health-related quality of life, self-care knowledge-attitudes-practice, postoperative anxiety and depression, compliance with attending scheduled follow-up visits, and the incidence of postoperative complications were evaluated at baseline and 6 months' postintervention for the two groups. The result showed that the interventions had a better effect on self-care knowledge-attitudes-practice, postoperative anxiety and depression, and compliance with attending scheduled follow-up visits in the peer support group than in the usual care group. This study confirms that telephone-based peer support improves self-care ability, compliance with attending scheduled follow-up visits, and reduces postoperative anxiety and depression more effectively than conventional nurse care among patients with cardiac pacemaker implantation.
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Affiliation(s)
- Zhiying Shen
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
| | - Feng Zheng
- Cardiovascular Intensive Care Unit, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhuqing Zhong
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
| | - Lu Wang
- Xiangya Nursing School, Central South University, Changsha, China
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Shepardson RL, Johnson EM, Possemato K, Arigo D, Funderburk JS. Perceived barriers and facilitators to implementation of peer support in Veterans Health Administration Primary Care-Mental Health Integration settings. Psychol Serv 2018; 16:433-444. [PMID: 30407053 DOI: 10.1037/ser0000242] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Peer support is increasingly recognized as consistent with the goals of integrated primary care and is being implemented in primary care settings as a patient-centered approach that increases patient activation and access to care. Within the Veterans Health Administration (VHA), peer support specialists (PSSs) have traditionally worked in specialty mental health settings and only recently started working in Primary Care-Mental Health Integration (PC-MHI) settings. Prior research has identified implementation challenges, such as role confusion, when integrating peer support into new settings. In this qualitative descriptive study, we conducted semistructured interviews on perceived barriers and facilitators to implementing peer support in PC-MHI with 25 key stakeholders (7 PSSs, 6 PSS supervisors, 6 PC-MHI providers, and 6 primary care providers). We used conventional content analysis to code responses within four a priori implementation categories: barriers, initial facilitators, long-term facilitators, and leadership support. Perceived barriers included poor program functioning, inadequate administrative support, role confusion, and negative stakeholder attitudes. Key perceived facilitators of initializing and maintaining peer support were similar; administrative support was emphasized followed by program functioning and team cohesion. Stakeholder buy-in and access/visibility were perceived to facilitate initial implementation, whereas evidence of success was believed to facilitate maintenance. Stakeholder buy-in and administrative support were considered key elements of leadership support. Results were consistent with prior research from specialty mental health settings, but identified unique considerations for PC-MHI settings, particularly clarifying the PSS role based on local PC-MHI needs, obtaining buy-in, and facilitating integration of PSSs into the primary care team. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Emily M Johnson
- Center for Integrated Healthcare, Syracuse VA Medical Center
| | - Kyle Possemato
- Center for Integrated Healthcare, Syracuse VA Medical Center
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Peer support opportunities across the cancer care continuum: a systematic scoping review of recent peer-reviewed literature. Support Care Cancer 2018; 27:97-108. [PMID: 30293093 DOI: 10.1007/s00520-018-4479-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/18/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Evidence suggests peer support (PS) is as an effective strategy for enhancing prevention and control of chronic and infectious diseases, including cancer. This systematic scoping review examines the range and variety of interventions on the use of PS across the cancer care continuum. METHOD We used a broad definition of PS to capture a wide-range of interventions and characterize the current status of the field. Literature searches were conducted using PubMed, SCOPUS, and CINAHL to identify relevant articles published from January 2011 to June 2016. We screened the title and abstracts of 2087 articles, followed by full-text screening of 420 articles, resulting in a final sample of 242 articles of which the most recent 100 articles were reviewed (published June 2014 to May 2016). RESULTS A number of the recent intervention studies focused on breast cancer (32%, breast cancer only) or multiple cancer sites (23%). Although the interventions spanned all phases of the cancer care continuum, only 2% targeted end-of-life care. Seventy-six percent focused on clinical outcomes (e.g., screening, treatment adherence) and 72% on reducing health disparities. Interventions were primarily phone-based (44%) or delivered in a clinic setting (44%). Only a few studies (22%) described the impact of providing PS on peer supporters. CONCLUSION PS appears to be a widely used approach to address needs across the cancer care continuum, with many opportunities to expand its reach.
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Aziz Z, Mathews E, Absetz P, Sathish T, Oldroyd J, Balachandran S, Shetty SS, Thankappan KR, Oldenburg B. A group-based lifestyle intervention for diabetes prevention in low- and middle-income country: implementation evaluation of the Kerala Diabetes Prevention Program. Implement Sci 2018; 13:97. [PMID: 30021592 PMCID: PMC6052531 DOI: 10.1186/s13012-018-0791-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 07/03/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND While several efficacy trials have demonstrated diabetes risk reduction through targeting key lifestyle behaviours, there is a significant evidence gap in relation to the successful implementation of such interventions in low- and middle-income countries (LMICs). This paper evaluates the implementation of a cluster randomised controlled trial of a group-based lifestyle intervention among individuals at high-risk of developing type 2 diabetes mellitus (T2DM) in the state of Kerala, India. Our aim is to uncover provider-, participant- and community-level factors salient to successful implementation and transferable to other LMICs. METHODS The 12-month intervention program consisted of (1) a group-based peer-support program consisting of 15 sessions over a period of 12 months for high-risk individuals, (2) peer leader (PL) training and ongoing support for intervention delivery, (3) diabetes education resource materials and (4) strategies to stimulate broader community engagement. The evaluation was informed by the RE-AIM and PIPE frameworks. RESULTS Provider-level factors: Twenty-nine (29/30, 97%) intervention groups organised all 15 sessions. A 2-day PL training was attended by 51(85%) of 60 PLs. The PL handbook was found to be 'very useful' by 78% of PLs. Participant-level factors: Of 1327 eligible individuals, 1007(76%) participants were enrolled. On average, participants attended eight sessions. Sixty-eight percent rated their interest in group sessions as 'very interested', and 55% found the group sessions 'very useful' in making lifestyle changes. Inconvenient time (43%) and location (21%) were found to be important barriers for participants who did not attend any sessions. Community-level factors: Community-based activities reached to 41% of the participants for walking groups, 40% for kitchen garden training, and 31% for yoga training. PLs were readily available for support outside the sessions, as 75% of participants reported extracurricular contacts with their PLs. The commitment from the local partner institute and political leaders facilitated the high uptake of the program. CONCLUSION A comprehensive evaluation of program implementation from the provider-, participant- and community-level perspectives demonstrates that the K-DPP program was feasible and acceptable in changing lifestyle behaviours in high-risk individuals. The findings from this evaluation will guide the future delivery of structured lifestyle modification diabetes programs in LMICs. TRIAL REGISTRATION Trial registration: Australia and New Zealand Clinical Trials Registry ACTRN12611000262909 . Registered 10 March 2011.
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Affiliation(s)
- Zahra Aziz
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. .,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Australia.
| | - Elezebeth Mathews
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, India
| | - Pilvikki Absetz
- School of Health Sciences, University of Tampere, Tampere, Finland.,Collaborative Care Systems Finland, Helsinki, Finland
| | - Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - John Oldroyd
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sajitha Balachandran
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Suman S Shetty
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - K R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, 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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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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Hartzler AL, Tuzzio L, Hsu C, Wagner EH. Roles and Functions of Community Health Workers in Primary Care. Ann Fam Med 2018; 16:240-245. [PMID: 29760028 PMCID: PMC5951253 DOI: 10.1370/afm.2208] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/13/2017] [Accepted: 01/11/2017] [Indexed: 11/09/2022] Open
Abstract
Community health workers have potential to enhance primary care access and quality, but remain underutilized. To provide guidance on their integration, we characterized roles and functions of community health workers in primary care through a literature review and synthesis. Analysis of 30 studies identified 12 functions (ie, care coordination, health coaching, social support, health assessment, resource linking, case management, medication management, remote care, follow-up, administration, health education, and literacy support) and 3 prominent roles representing clusters of functions: clinical services, community resource connections, and health education and coaching. We discuss implications for community health worker training and clinical support in primary care.
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Affiliation(s)
- Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Edward H Wagner
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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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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Jull J, Mazereeuw M, Sheppard A, Kewayosh A, Steiner R, Graham ID. Tailoring and field-testing the use of a knowledge translation peer support shared decision making strategy with First Nations, Inuit and Métis people making decisions about their cancer care: a study protocol. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:6. [PMID: 29507771 PMCID: PMC5831595 DOI: 10.1186/s40900-018-0085-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/08/2018] [Indexed: 06/08/2023]
Abstract
PLAIN ENGLISH SUMMARY Tailoring and testing a peer support decision making strategy with First Nations, Inuit and Métis people making decisions about their cancer care: A study protocol.First Nations, Inuit and Métis (FNIM) people face higher risks for cancer compared to non-FNIM populations. They also face cultural barriers to health service use. Within non-FNIM populations an approach to health decision making, called shared decision making (SDM), has been found to improve the participation of people in their healthcare. Peer support with SDM further improves these benefits. The purpose of this study is to tailor and test a peer support SDM strategy with community support workers to increase FNIM people's participation in their cancer care.This project has two phases that will be designed and conducted with a Steering Committee that includes members of the FNIM and cancer care communities. First, a peer support SDM strategy will be tailored to meet the needs of cancer system users who are receiving care in urban settings, and training in the SDM strategy developed for community support workers. Three communities will be supported for participation in the study and community support workers who are peers from each community will be trained to use the SDM strategy.Next, each community support worker will work with a community member who has a diagnosis of cancer or who has supported a family member with cancer. Each community support worker and community member pair will use the SDM strategy. The participation and experience of the community support worker and community member will be evaluated.The research will be used to develop strategies to support people who are making decisions about their health. ABSTRACT Tailoring and field-testing the use of a knowledge translation peer support shared decision making strategy with First Nations, Inuit and Métis people making decisions about their cancer care: A study protocol Background First Nations, Inuit and Métis ("FNIM") people face increased cancer risks in relation to general populations and experience barriers to health service use. Shared decision making (SDM) has been found to improve peoples' participation and outcomes in healthcare and peer support with SDM further improves these benefits. The purpose of this study is to tailor and then field test, by and with FNIM communities, a peer support SDM strategy for use in cancer care. Methods This project has 2 theory-driven phases and 5 stages (a-e). A core research team that includes members of the Aboriginal Cancer Control Unit of Cancer Care Ontario communities and academic researchers, will work with a Steering Committee. In phase 1, (stage a) a peer support SDM strategy will be tailored to meet the needs of cancer system users who are receiving care in urban settings and (stage b), training developed that will i) introduce participant communities to SDM, and ii) train community support workers (CSWs) within these communities. Next (stage c), three communities will be approached for voluntary participation in the study. These communities will be introduced to SDM in community meetings, and if in agreement then CSWs from each community will be recruited to participate in the study. One volunteer CSW from each community will be trained to use the peer support SDM strategy to enable phase 2 (field test of the peer support SDM strategy).During phase 2 (stage d), each CSW will be matched to a volunteer community member who has had a diagnosis of cancer or has supported a family member with cancer and is familiar with Ontario cancer systems. Each CSW-community member pair (3 to 4 pairs/community) will use the tailored peer support SDM strategy; their interaction will be audio-recorded and their participation and experience evaluated (total of 9 to 12 interviews). As well (stage e), data will be collected on health systems' factors related to the use of the peer support SDM strategy. Discussion Findings will develop peer support SDM strategies to enhance participation of FNIM people in cancer care decisions, advance knowledge translation science, and support a proposal to conduct a multi-site implementation trial.
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Affiliation(s)
- Janet Jull
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario Canada
| | - Maegan Mazereeuw
- Aboriginal Cancer Control Unit, Cancer Care Ontario, Toronto, Ontario Canada
| | - Amanada Sheppard
- Aboriginal Cancer Control Unit, Cancer Care Ontario, Toronto, Ontario Canada
| | - Alethea Kewayosh
- Aboriginal Cancer Control Unit, Cancer Care Ontario, Toronto, Ontario Canada
| | - Richard Steiner
- Aboriginal Cancer Control Unit, Cancer Care Ontario, Toronto, Ontario Canada
| | - Ian D. Graham
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario Canada
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Lutes LD, Cummings DM, Littlewood K, Dinatale E, Hambidge B. A Community Health Worker-Delivered Intervention in African American Women with Type 2 Diabetes: A 12-Month Randomized Trial. Obesity (Silver Spring) 2017; 25:1329-1335. [PMID: 28660719 DOI: 10.1002/oby.21883] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a community health worker (CHW)-delivered lifestyle intervention for African American women with type 2 diabetes. METHODS Participants were randomized to either 16 phone-based lifestyle intervention sessions aimed at making small changes in their diet and activity or 16 educational mailings sent across 12 months. Main outcomes included glycosylated hemoglobin (HbA1c), blood pressure (BP), and weight (kg) changes. RESULTS Two hundred middle-aged (mean = 53 ± 10.24 years), rural, African American women with moderate obesity (mean BMI = 37.7 ± 8.02) and type 2 diabetes (mean HbA1c = 9.1 ± 1.83) were enrolled. At 12 months, the intervention group exhibited no significant differences in HbA1c (-0.29 ± 1.84 vs. + 0.005 ± 1.61; P = 0.789) or BP (-1.01 ± 20.46/+0.66 ± 13.24 vs. + 0.22 ± 25.33/-2.87 ± 1.52; P = 0.100) but did exhibit greater weight loss (-1.35 ± 6.22 vs. -0.39 ± 4.57 kg, respectively; P = 0.046) compared with controls. Exploratory post hoc analyses revealed that participants not using insulin had significantly greater reductions in HbA1c (-0.70 ± 1.86 vs. + 0.07 ± 2.01; P = 0.000), diastolic BP (-5.17 ± 14.16 vs. -3.40 ± 14.72 mmHg; P = 0.035), and weight (-2.36 ± 6.59 vs. -1.64 ± 4.36 kg; P = 0.003) compared to controls not on insulin. CONCLUSIONS A phone-based CHW intervention resulted in no significant improvements in HbA1c or BP but did demonstrate modest improvements in weight. Women not using insulin showed significant improvements in all primary outcomes.
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Affiliation(s)
- Lesley D Lutes
- Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada
| | - Doyle M Cummings
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
- Center for Health Disparities, East Carolina University, Greenville, North Carolina, USA
| | - Kerry Littlewood
- School of Social Work, University of South Florida, Tampa, Florida, USA
| | - Emily Dinatale
- Primary Care Mental Health Integration, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA
| | - Bertha Hambidge
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
- Center for Health Disparities, East Carolina University, Greenville, North Carolina, USA
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Rocque GB, Halilova KI, Varley AL, Williams CP, Taylor RA, Masom DG, Wright WJ, Partridge EE, Kvale EA. Feasibility of a Telehealth Educational Program on Self-Management of Pain and Fatigue in Adult Cancer Patients. J Pain Symptom Manage 2017; 53:1071-1078. [PMID: 28185891 PMCID: PMC8641243 DOI: 10.1016/j.jpainsymman.2016.12.345] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/12/2016] [Accepted: 12/29/2016] [Indexed: 02/08/2023]
Abstract
CONTEXT Pain and fatigue are common symptoms among cancer patients and often lead to substantial distress. Innovative self-management programs for pain and fatigue are needed. OBJECTIVES The primary objective was to assess the feasibility of a telehealth pain and fatigue self-management program among adult cancer patients. Secondary objectives included assessment of differences in patient characteristics, recruitment, and retention of patients based on two screening strategies: 1) navigator-collected, patient-reported pain or fatigue and 2) in-clinic, physician-identified pain or fatigue. METHODS This prospective, nonrandomized, pre-post evaluation assessed feasibility, which was defined as 50% of eligible patients choosing to participate and completing the intervention. Patient demographics and patient-reported outcomes (patient activation, distress, symptoms, and quality of life) were collected at baseline and study completion. Differences in baseline characteristics were compared between cohorts and for patients who did vs. did not graduate from the program. RESULTS The program did not meet feasibility requirements because of only 34% of eligible patients choosing to participate. However, 50% of patients starting the program graduated. Differences in baseline characteristics and retention rates were noted by recruitment strategy. At baseline, 27.3% of navigated patients were at the highest activation level compared with 7.1% in the physician-referred, non-navigated patients (P = 0.17); more than 15% of non-completers were at the lowest activation level compared with 9% of completers (P = 0.85). CONCLUSION Telehealth self-management program for pain and fatigue may be better accepted among selected segments of cancer patients. Larger scale studies are needed to assess the efficacy of this program in a more selective activated population.
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Affiliation(s)
- Gabrielle B Rocque
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Karina I Halilova
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Allyson L Varley
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Courtney P Williams
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard A Taylor
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | - Edward E Partridge
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth A Kvale
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Fisher EB, Boothroyd RI, Elstad EA, Hays L, Henes A, Maslow GR, Velicer C. Peer support of complex health behaviors in prevention and disease management with special reference to diabetes: systematic reviews. Clin Diabetes Endocrinol 2017; 3:4. [PMID: 28702258 PMCID: PMC5471959 DOI: 10.1186/s40842-017-0042-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/09/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Examine Peer Support (PS) for complex, sustained health behaviors in prevention or disease management with emphasis on diabetes prevention and management. DATA SOURCES AND ELIGIBILITY PS was defined as emotional, motivational and practical assistance provided by nonprofessionals for complex health behaviors. Initial review examined 65 studies drawn from 1442 abstracts identified through PubMed, published 1/1/2000-7/15/2011. From this search, 24 reviews were also identified. Extension of the search in diabetes identified 30 studies published 1/1/2000-12/31/2015. RESULTS In initial review, 54 of all 65 studies (83.1%) reported significant impacts of PS, 40 (61.5%) reporting between-group differences and another 14 (21.5%) reporting significant within-group changes. Across 19 of 24 reviews providing quantifiable findings, a median of 64.5% of studies reviewed reported significant effects of PS. In extended review of diabetes, 26 of all 30 studies (86.7%) reported significant impacts of PS, 17 (56.7%) reporting between-group differences and another nine (30.0%) reporting significant within-group changes. Among 19 of these 30 reporting HbA1c data, average reduction was 0.76 points. Studies that did not find effects of PS included other sources of support, implementation or methodological problems, lack of acceptance of interventions, poor fit to recipient needs, and possible harm of unmoderated PS. CONCLUSIONS Across diverse settings, including under-resourced countries and health care systems, PS is effective in improving complex health behaviors in disease prevention and management including in diabetes.
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Affiliation(s)
- Edwin B. Fisher
- Peers for Progress, Gillings School of Global Public Health, University of North Carolina, Box 7440, Chapel Hill, NC 27599-7440 USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Box 7440, Chapel Hill, NC 27599-7440 USA
| | - Renée I. Boothroyd
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC USA
| | | | - Laura Hays
- Indiana University School of Nursing, Indianapolis, IN USA
| | - Amy Henes
- RTI International, Research Triangle Park, NC USA
| | - Gary R. Maslow
- Department of Pediatrics, Duke University, Durham, NC USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC USA
| | - Clayton Velicer
- National Public Relations and Communications, Kaiser Permanente, Oakland, CA USA
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Kowitt SD, Ayala GX, Cherrington AL, Horton LA, Safford MM, Soto S, Tang TS, Fisher EB. Examining the Support Peer Supporters Provide Using Structural Equation Modeling: Nondirective and Directive Support in Diabetes Management. Ann Behav Med 2017; 51:810-821. [DOI: 10.1007/s12160-017-9904-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Stetson B, Minges KE, Richardson CR. New directions for diabetes prevention and management in behavioral medicine. J Behav Med 2017; 40:127-144. [PMID: 27743230 PMCID: PMC5950714 DOI: 10.1007/s10865-016-9802-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 10/05/2016] [Indexed: 12/20/2022]
Abstract
Accelerating diabetes rates have resulted in a global public health epidemic. Lifestyle change is a cornerstone of care, yet regimen demands may result in adherence difficulties. Distress, depression, and other psychosocial concerns are higher in those with diabetes. While interventions, such as the Diabetes Prevention Program appear to be effective, further research is needed to support the translation of interventions to prevent diabetes. Studies assessing optimal approaches to promoting effective decision making, coping and adherence are needed. More information is needed to evaluate the influence and potential of emerging technologies on intervention delivery and quality of life in children and adults with diabetes. Theoretically informed, interdisciplinary studies that consider ecological models are needed to develop a roadmap for policies and diabetes management recommendations. Reduction of diabetes-related health disparities is a critical area for future studies. Behavioral medicine scientists and practitioners are poised to address these and other proposed future research directions to advance diabetes prevention and management.
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Affiliation(s)
- Barbara Stetson
- Department of Psychological and Brain Sciences, University of Louisville, 317 Life Sciences Building, Louisville, KY, 40292, USA.
| | - Karl E Minges
- School of Nursing, Yale University, Orange, CT, 06447, USA
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Joensen LE, Meldgaard Andersen M, Jensen S, Nørgaard K, Willaing I. The effect of peer support in adults with insulin pump-treated type 1 diabetes: a pilot study of a flexible and participatory intervention. Patient Prefer Adherence 2017; 11:1879-1890. [PMID: 29138541 PMCID: PMC5679694 DOI: 10.2147/ppa.s142204] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM The aim of this study was to explore the effects of a flexible and participatory peer support intervention in a clinical setting for adults with type 1 diabetes treated with an insulin pump, focusing on enhancing diabetes-specific social capital. The key questions were as follows: 1) what effects are appropriate to expect, according to participants? and 2) to what extent did these effects occur? METHODS Two peer support intervention programs were conducted in a diabetes specialist clinic (N=30). A participatory and adaptable approach allowed flexibility in the content of peer support meetings, which were facilitated by a diabetes nurse. Individual interviews explored participants' perception of effects of the intervention. Interview data were analyzed qualitatively. Participants (n=27) completed a baseline and postintervention questionnaire that included items assessing diabetes empowerment, diabetes distress, diabetes-specific social support, and diabetes loneliness. HbA1c levels were compared before and after the intervention. RESULTS Participants experienced enhanced diabetes-specific social capital, diabetes motivation, awareness of personal diabetes practices, and serenity and openness in life with diabetes. They also became more aware of treatment and support possibilities. Negative effects included feeling sad or upset after the meetings or feeling different than and not as well-controlled as other participants. Quantitative analyses showed enhanced social support, decreased eating distress and trends toward enhanced diabetes empowerment, decreased diabetes loneliness, and decreased diabetes distress (powerlessness). We found fewer positive and/or negative outcomes among participants who felt no need for peer support or felt that the group was not a unit or that important issues were not addressed. CONCLUSION The study indicated that flexible and participatory peer support can strengthen diabetes-specific social capital and improve participants' well-being and diabetes empowerment. Awareness of participants' incentives for attending peer support, as well as the risk of people feeling isolated within peer support groups, is essential to creating effective diabetes-specific social support.
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Affiliation(s)
- Lene Eide Joensen
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte
| | | | - Sabrina Jensen
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte
| | - Kirsten Nørgaard
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark
| | - Ingrid Willaing
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte
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Manchaiah V, Pyykkö I, Zou J, Levo H, Kentala E. Patient-reported benefits from patient organization magazines and Internet-based peer support in Ménière's disease. Patient Prefer Adherence 2017; 11:1851-1857. [PMID: 29138539 PMCID: PMC5667786 DOI: 10.2147/ppa.s142257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To facilitate self-help, the Finnish Ménière's Federation (FMF) provides various kinds of support to persons with Ménière's disease (MD), which includes patient magazines (PM) and Internet-based peer support (iPS). The current study aimed to evaluate the benefits reported by MD patients in terms of PM and iPS. METHOD The study used a cross-sectional survey design with a mixture of structured and open-ended questions administered online. A sample of 185 patients from the FMF membership database provided complete data. RESULTS Ninety-two percent of the respondents rated PM as useful, or very useful. The main benefits of PM included: information on the disease and complaints, information about elements of peer support program, patient's experience with useful positive case studies, relevant news on MD, and information of activity of the FMF. Of the 185 persons, 68 reported that they did not have a need for peer support as their disease was either in silent phase or did not cause any annoyance. The main reasons for nonuse were: mild disease, personal reasons, and problems in using. Regarding the benefits of iPS, 75% of recent and 64% of chronic MD patients said that they would benefit from such a program. The main benefits of iPS included: reliable information on the disease and its management, peer support useful for coping with the disease, information about managing MD symptoms, information about managing attitude, and information about therapy. Moreover, the study identified different groups of individuals, which included: nonusers of support from patient organizations, those who used the support but did not feel they benefited, and those who used and also benefited from such programs. CONCLUSION The current study results provide some information about the preferences of MD patients regarding different forms of support and could certainly prove helpful while developing wider support strategies.
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Affiliation(s)
- Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
- Department of Behavioural Sciences and Learning, The Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
- Audiology India, Mysore
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
- Correspondence: Vinaya Manchaiah, Department of Speech and Hearing Sciences, Lamar University, PO Box 10076, Beaumont 77010, TX, USA, Tel +1 409 880 8927, Fax +1 409 880 2265, Email
| | - Ilmari Pyykkö
- Department of Otolaryngology, Hearing and Balance Research Unit, University of Tampere, Tampere, Finland
| | - Jing Zou
- Department of Otolaryngology, Hearing and Balance Research Unit, University of Tampere, Tampere, Finland
- Department of Otolaryngology-Head and Neck Surgery, Center for Otolaryngology-Head & Neck Surgery of Chinese PLA, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hilla Levo
- Department of Otolaryngology, University of Helsinki, Helsinki, Finland
| | - Erna Kentala
- Department of Otolaryngology, University of Helsinki, Helsinki, Finland
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Joensen LE, Filges T, Willaing I. Patient perspectives on peer support for adults with type 1 diabetes: a need for diabetes-specific social capital. Patient Prefer Adherence 2016; 10:1443-51. [PMID: 27536076 PMCID: PMC4977079 DOI: 10.2147/ppa.s111696] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To explore the function of peer support from the perspective of adults with type 1 diabetes in Denmark. METHODS The study population consisted of 20 adults with type 1 diabetes. The sample was diverse in relation to educational background, age, sex, and cohabitation status. Inspired by action research, several methods and perspectives on peer support were explored and tested. Workshops and group and individual interviews were performed. Systematic text condensation was used to analyze data, supplemented with theory-based interpretive analysis. RESULTS Adults with type 1 diabetes found peer support highly relevant to reduce a burdensome feeling of diabetes-specific loneliness. Peer support showed potential to create diabetes-specific social capital not only by creating reciprocal social support between peers but also, more importantly, by creating space for genuine trust and a feeling of communality. There was a widespread feeling of the pervasive impact of diabetes on daily life and thus the relevance of discussing all aspects of life. However, participants perceived peer support as particularly relevant in relation to big changes in life, for example, in family life, at work, or through treatment events such as getting an insulin pump. CONCLUSION Peer support programs focusing on creating and establishing diabetes-specific social capital using participatory approaches seem highly relevant among adults with type 1 diabetes. Content, methods, and effects of peer support need further exploration in collaboration with adults with type 1 diabetes.
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Affiliation(s)
- Lene E Joensen
- Health Promotion Research, Steno Diabetes Center, Gentofte
- Correspondence: Lene E Joensen, Health Promotion Research, Steno Diabetes Center, Niels Steensens Vej 2, DK-2820 Gentofte, Denmark, Tel +45 3075 5281, Email
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