Effectiveness of Technologically Enhanced Peer Support in Improving Glycemic Management Among Predominantly African American,Low-Income Adults With Diabetes

Abstract

Purpose

The purpose of the study was to examine whether a peer coaching intervention is more effective in improving clinical outcomes in diabetes when enhanced with e-health educational tools than peer coaching alone.

Methods

The effectiveness of peer coaches who used an individually tailored, interactive, web-based tool (iDecide) was compared with peer coaches with no access to the tool. Two hundred and ninety Veterans Affairs patients with A1C ≥8.0% received a 6-month intervention with an initial session with a fellow patient trained to be a peer coach, followed by weekly phone calls to discuss behavioral goals. Participants were randomized to coaches who used iDecide or coaches who used nontailored educational materials at the initial session. Outcomes were A1C (primary), blood pressure, and diabetes social support (secondary) at 6 and 12 months.

Results

Two hundred and fifty-five participants (88%) completed 6-month and 237 (82%) 12-month follow-up. Ninety-eight percent were men, and 63% were African American. Participants in both groups improved A1C values (>–0.6%, P < .001) at 6 months and maintained these gains at 12-month follow-up ( >–0.5%, P < .005). Diabetes social support was improved at both 6 and 12 months (P < .01). There were no changes in blood pressure.

Conclusions

Clinical gains achieved through a volunteer peer coach program were not increased by the addition of a tailored e-health educational tool.

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References

Heisler

Faul

Hayward

Langa

Blaum

Weir

. Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study. Arch Intern Med. 2007;167(17):1853-1860.

Peek

Cargill

Huang

. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007;64(suppl 5):101S-156S.

Department of Veterans Affairs. VHA Office of Quality and Performance report. http://vaww.pdw.med.va.gov/MeasureMaster/MMReport.asp. Accessed June 29, 2011.

Heisler

Smith

Hayward

Krein

Kerr

. Racial disparities in diabetes care processes, outcomes, and treatment intensity. Med Care. 2003;41(11):1221-1232.

Cooper

Beach

Johnson

Inui

. Delving below the surface. Understanding how race and ethnicity influence relationships in health care. J Gen Intern Med. 2006;21(suppl 1):S21-S27.

Cooper

Roter

Carson

et al . The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012;102(5):979-987.

Frosch

May

Rendle

Tietbohl

Elwyn

. Authoritarian physicians and patients’ fear of being labeled “difficult” among key obstacles to shared decision making. Health Aff (Millwood). 2012;31(5):1030-1038.

Peek

Quinn

Gorawara-Bhat

Odoms-Young

Wilson

Chin

. How is shared decision-making defined among African-Americans with diabetes? Patient Educ Couns. 2008;72(3):450-458.

Rosland

Kieffer

Israel

et al . When is social support important? The association of family support and professional support with specific diabetes self-management behaviors. J Gen Intern Med. 2008;23(12):1992-1999.

10.

Dennis

. Peer support within a health care context: a concept analysis. Int J Nurs Stud. 2003;40(3):321-332.

11.

Armstrong

McMurphy

Dean

et al . Differences in the patterns of health care system distrust between blacks and whites. J Gen Intern Med. 2008;23(6):827-833.

12.

Ghorob

Vivas

De Vore

et al . The effectiveness of peer health coaching in improving glycemic control among low-income patients with diabetes: protocol for a randomized controlled trial. BMC Public Health. 2011;11:208.

13.

Heisler

Vijan

Makki

Piette

. Diabetes control with reciprocal peer support versus nurse care management: a randomized trial. Ann Intern Med. 2010;153(8):507-515.

14.

Long

Jahnle

Richardson

Loewenstein

Volpp

. Peer mentoring and financial incentives to improve glucose control in African American veterans: a randomized trial. Ann Intern Med. 2012;156(6):416-424.

15.

Philis-Tsimikas

Fortmann

Lleva-Ocana

et al . Peer-led diabetes education programs in high-risk Mexican Americans improve glycemic control compared with standard approaches: a Project Dulce promotora randomized trial. Diabetes Care. 2011;34(9):1926-1931.

16.

Thom

Ghorob

Hessler

et al . Impact of peer health coaching on glycemic control in low-income patients with diabetes: a randomized controlled trial. Ann Fam Med. 2013;11(2):137-144.

17.

Zhang

Yang

Sun

Fisher

Sun

. How to achieve better effect of peer support among adults with type 2 diabetes: a meta-analysis of randomized clinical trials. Patient Educ Couns. 2016;99(2):186-197.

18.

Neville

O’Hara

Milat

. Computer-tailored dietary behaviour change interventions: a systematic review. Health Educ Res. 2009;24(4):699-720.

19.

Noar

Benac

Harris

. Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychol Bull. 2007;133(4):673-693.

20.

Adams

Crawford

Rimal

Lee

Janneck

Sciamanna

. The effects of a computer-tailored message on secondary prevention in type 2 diabetes: a randomized trial. Popul Health Manag. 2009;12(4):197-204.

21.

Mullan

Montori

Shah

et al . The diabetes mellitus medication choice decision aid: a randomized trial. Arch Intern Med. 2009;169(17):1560-1568.

22.

Wallace

Seligman

Davis

et al . Literacy-appropriate educational materials and brief counseling improve diabetes self-management. Patient Educ Couns. 2009;75(3):328-333.

23.

Krebs

Prochaska

Rossi

. A meta-analysis of computer-tailored interventions for health behavior change. Prev Med. 2010;51(3-4):214-221.

24.

Stacey

Belkora

Clay

et al . 2012 update of the IPDAS collaboration background document. http://ipdas.ohri.ca/resources.html. Accessed March 25, 2019.

25.

Wilkinson

Nathan

Huang

. Personalized decision support in type 2 diabetes mellitus: current evidence and future directions. Curr Diab Rep. 2013;13(2):205-212.

26.

Gibbons

Wilson

Samal

et al . Impact of Consumer Health Informatics Applications. Evidence Report/Technology Assessment No. 188. Rockville, MD: AHRQ; 2009.

27.

Heisler

Choi

Palmisano

et al . Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial. Ann Intern Med. 2014;161(suppl 10):S13-S22.

28.

Henderson

Barr

et al . Community-based participatory research and user-centered design in a diabetes medication information and decision tool. Prog Community Health Partnersh. 2013;7(2):171-184.

29.

Moskowitz

Thom

Hessler

Ghorob

Bodenheimer

. Peer coaching to improve diabetes self-management: which patients benefit most? J Gen Intern Med. 2013;28(7):938-942.

30.

Piette

Resnicow

Choi

Heisler

. A diabetes peer support intervention that improved glycemic control: mediators and moderators of intervention effectiveness. Chronic Illn. 2013;9(4):258-267.

31.

Goei

Schechtel

Meyer

et al . Premixed Insulin for Type 2 Diabetes. Effective Health Care. Rockville, MD: Agency for Healthcare Research and Quality; 2009.

32.

Robinson

Rugge

Schechtel

et al . Pills for Type 2 Diabetes. Effective Health Care. Rockville, MD: Agency for Healthcare Research and Quality; 2007.

33.

Weymiller

Montori

Jones

et al . Helping patients with type 2 diabetes mellitus make treatment decisions: statin choice randomized trial. Arch Intern Med. 2007;167(10):1076-1082.

34.

Arsie

Marchioro

Lapolla

et al . Evaluation of diagnostic reliability of DCA 2000 for rapid and simple monitoring of HbA1c. Acta Diabetol. 2000;37(1):1-7.

35.

American Heart Association. Understanding blood pressure readings. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#.Wl-XSzYUnDA. Accessed January 15, 2018.

36.

Barrera

Jr Glasgow

McKay

Boles

Feil

. Do internet-based support interventions change perceptions of social support?: an experimental trial of approaches for supporting diabetes self-management. Am J Community Psychol. 2002;30(5):637-654.

37.

Campbell

Grimshaw

Steen

. Sample size calculations for cluster randomised trials. Changing Professional Practice in Europe Group (EU BIOMED II Concerted Action). J Health Serv Res Policy. 2000;5(1):12-16.

38.

Schulz

Altman

Moher

. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Int J Surg. 2011;9(8):672-677.

39.

StataCorp. Stata: Release 14. Statistical Software. College Station, TX: StataCorp LP; 2015. [computer program].

40.

Fisher

Ballesteros

Bhushan

et al . Key features of peer support in chronic disease prevention and management. Health Aff (Millwood). 2015;34(9):1523-1530.

41.

Tang

Funnell

Sinco

Spencer

Heisler

. Peer-led, empowerment-based approach to self-management efforts in diabetes (PLEASED): a randomized controlled trial in an African American Community. Ann Fam Med. 2015;13(suppl 1):S27-S35.

42.

Tang

Funnell

Sinco

et al . Comparative effectiveness of peer leaders and community health workers in diabetes self-management support: results of a randomized controlled trial. Diabetes Care. 2014;37(6):1525-1534.

43.

UKPDS. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837-853.