Peer Coaches to Improve Diabetes Outcomes in Rural Alabama: A Cluster Randomized Trial
It is unclear whether peer coaching is effective in minority populations living with diabetes in hard-to-reach, under-resourced areas such as the rural South. We examined the effect of an innovative peer-coaching intervention plus brief education vs brief education alone on diabetes outcomes. This w...
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| Veröffentlicht in: | Annals of family medicine 2015-08, Vol.13 Suppl 1 (Suppl_1), p.S18-S26 |
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| container_title | Annals of family medicine |
| container_volume | 13 Suppl 1 |
| creator | Safford, Monika M Andreae, Susan Cherrington, Andrea L Martin, Michelle Y Halanych, Jewell Lewis, Marquita Patel, Ashruta Johnson, Ethel Clark, Debra Gamboa, Christopher Richman, Joshua S |
| description | It is unclear whether peer coaching is effective in minority populations living with diabetes in hard-to-reach, under-resourced areas such as the rural South. We examined the effect of an innovative peer-coaching intervention plus brief education vs brief education alone on diabetes outcomes.
This was a community-engaged, cluster-randomized, controlled trial with primary care practices and their surrounding communities serving as clusters. The trial enrolled 424 participants, with 360 completing baseline and follow-up data collection (84.9% retention). The primary outcomes were change in glycated hemoglobin (HbA1c), systolic blood pressure (BP), low density lipoprotein cholesterol (LDL-C), body mass index (BMI), and quality of life, with diabetes distress and patient activation as secondary outcomes. Peer coaches were trained for 2 days in community settings; the training emphasized motivational interviewing skills, diabetes basics, and goal setting. All participants received a 1-hour diabetes education class and a personalized diabetes report card at baseline. Intervention arm participants were also paired with peer coaches; the protocol called for telephone interactions weekly for the first 8 weeks, then monthly for a total of 10 months.
Due to real-world constraints, follow-up was protracted, and intervention effects varied over time. The analysis that included the 68% of participants followed up by 15 months showed only a significant increase in patient activation in the intervention group. The analysis that included all participants who eventually completed follow-up revealed that intervention arm participants had significant differences in changes in systolic BP (P = .047), BMI (P = .02), quality of life (P = .003), diabetes distress (P = .004), and patient activation (P = .03), but not in HbA1c (P = .14) or LDL-C (P = .97).
Telephone-delivered peer coaching holds promise to improve health for individuals with diabetes living in under-resourced areas. |
| doi_str_mv | 10.1370/afm.1798 |
| format | Article |
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This was a community-engaged, cluster-randomized, controlled trial with primary care practices and their surrounding communities serving as clusters. The trial enrolled 424 participants, with 360 completing baseline and follow-up data collection (84.9% retention). The primary outcomes were change in glycated hemoglobin (HbA1c), systolic blood pressure (BP), low density lipoprotein cholesterol (LDL-C), body mass index (BMI), and quality of life, with diabetes distress and patient activation as secondary outcomes. Peer coaches were trained for 2 days in community settings; the training emphasized motivational interviewing skills, diabetes basics, and goal setting. All participants received a 1-hour diabetes education class and a personalized diabetes report card at baseline. Intervention arm participants were also paired with peer coaches; the protocol called for telephone interactions weekly for the first 8 weeks, then monthly for a total of 10 months.
Due to real-world constraints, follow-up was protracted, and intervention effects varied over time. The analysis that included the 68% of participants followed up by 15 months showed only a significant increase in patient activation in the intervention group. The analysis that included all participants who eventually completed follow-up revealed that intervention arm participants had significant differences in changes in systolic BP (P = .047), BMI (P = .02), quality of life (P = .003), diabetes distress (P = .004), and patient activation (P = .03), but not in HbA1c (P = .14) or LDL-C (P = .97).
Telephone-delivered peer coaching holds promise to improve health for individuals with diabetes living in under-resourced areas.</description><identifier>ISSN: 1544-1709</identifier><identifier>EISSN: 1544-1717</identifier><identifier>DOI: 10.1370/afm.1798</identifier><identifier>PMID: 26304967</identifier><language>eng</language><publisher>United States: American Academy of Family Physicians</publisher><subject>Aged ; Alabama ; Blood Pressure ; Body Mass Index ; Cholesterol, LDL - blood ; Cluster Analysis ; Counseling - methods ; Diabetes Mellitus - blood ; Diabetes Mellitus - psychology ; Diabetes Mellitus - therapy ; Female ; Glycated Hemoglobin A - analysis ; Humans ; Male ; Middle Aged ; Original Research ; Peer Group ; Quality of Life ; Rural Population ; Self Care - methods ; Self Care - psychology ; Social Support ; Telephone ; Treatment Outcome ; Vulnerable Populations</subject><ispartof>Annals of family medicine, 2015-08, Vol.13 Suppl 1 (Suppl_1), p.S18-S26</ispartof><rights>2015 Annals of Family Medicine, Inc.</rights><rights>2015 Annals of Family Medicine, Inc. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-eb426ba17761a35ab57d166a4b3937e7245ce68bbb14e9457433a92edc8c39a83</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648138/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648138/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,728,781,785,886,27928,27929,53795,53797</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26304967$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Safford, Monika M</creatorcontrib><creatorcontrib>Andreae, Susan</creatorcontrib><creatorcontrib>Cherrington, Andrea L</creatorcontrib><creatorcontrib>Martin, Michelle Y</creatorcontrib><creatorcontrib>Halanych, Jewell</creatorcontrib><creatorcontrib>Lewis, Marquita</creatorcontrib><creatorcontrib>Patel, Ashruta</creatorcontrib><creatorcontrib>Johnson, Ethel</creatorcontrib><creatorcontrib>Clark, Debra</creatorcontrib><creatorcontrib>Gamboa, Christopher</creatorcontrib><creatorcontrib>Richman, Joshua S</creatorcontrib><title>Peer Coaches to Improve Diabetes Outcomes in Rural Alabama: A Cluster Randomized Trial</title><title>Annals of family medicine</title><addtitle>Ann Fam Med</addtitle><description>It is unclear whether peer coaching is effective in minority populations living with diabetes in hard-to-reach, under-resourced areas such as the rural South. We examined the effect of an innovative peer-coaching intervention plus brief education vs brief education alone on diabetes outcomes.
This was a community-engaged, cluster-randomized, controlled trial with primary care practices and their surrounding communities serving as clusters. The trial enrolled 424 participants, with 360 completing baseline and follow-up data collection (84.9% retention). The primary outcomes were change in glycated hemoglobin (HbA1c), systolic blood pressure (BP), low density lipoprotein cholesterol (LDL-C), body mass index (BMI), and quality of life, with diabetes distress and patient activation as secondary outcomes. Peer coaches were trained for 2 days in community settings; the training emphasized motivational interviewing skills, diabetes basics, and goal setting. All participants received a 1-hour diabetes education class and a personalized diabetes report card at baseline. Intervention arm participants were also paired with peer coaches; the protocol called for telephone interactions weekly for the first 8 weeks, then monthly for a total of 10 months.
Due to real-world constraints, follow-up was protracted, and intervention effects varied over time. The analysis that included the 68% of participants followed up by 15 months showed only a significant increase in patient activation in the intervention group. The analysis that included all participants who eventually completed follow-up revealed that intervention arm participants had significant differences in changes in systolic BP (P = .047), BMI (P = .02), quality of life (P = .003), diabetes distress (P = .004), and patient activation (P = .03), but not in HbA1c (P = .14) or LDL-C (P = .97).
Telephone-delivered peer coaching holds promise to improve health for individuals with diabetes living in under-resourced areas.</description><subject>Aged</subject><subject>Alabama</subject><subject>Blood Pressure</subject><subject>Body Mass Index</subject><subject>Cholesterol, LDL - blood</subject><subject>Cluster Analysis</subject><subject>Counseling - methods</subject><subject>Diabetes Mellitus - blood</subject><subject>Diabetes Mellitus - psychology</subject><subject>Diabetes Mellitus - therapy</subject><subject>Female</subject><subject>Glycated Hemoglobin A - analysis</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original Research</subject><subject>Peer Group</subject><subject>Quality of Life</subject><subject>Rural Population</subject><subject>Self Care - methods</subject><subject>Self Care - psychology</subject><subject>Social Support</subject><subject>Telephone</subject><subject>Treatment Outcome</subject><subject>Vulnerable Populations</subject><issn>1544-1709</issn><issn>1544-1717</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUV1Lw0AQPESxtQr-ArlHX1JzuUsu8UEo8atQqJTq67GXbm0kl6t3SUF_vSnWUp922B1mhxlCLlk4ZFyGN7A0Qyaz9Ij0WSxEwCSTx3scZj1y5v1HGEYs4tEp6UUJD0WWyD55e0F0NLdQrNDTxtKxWTu7QXpfgsam203bprCmA2VNZ62Dio4q0GDglo5oXrW-6QRmUC-sKb9xQeeuhOqcnCyh8nixmwPy-vgwz5-DyfRpnI8mQcFl1ASoRZRoYFImDHgMOpYLliQgNM-4RBmJuMAk1VozgZmIpeAcsggXRVrwDFI-IHe_uutWm26NddM5VGtXGnBfykKp_l_qcqXe7UaJRKSMbwWudwLOfrboG2VKX2BVQY229apLT8Yxl-KAWjjrvcPl_g0L1bYG1dWgtjV01KtDW3viX-78B6ABgxg</recordid><startdate>201508</startdate><enddate>201508</enddate><creator>Safford, Monika M</creator><creator>Andreae, Susan</creator><creator>Cherrington, Andrea L</creator><creator>Martin, Michelle Y</creator><creator>Halanych, Jewell</creator><creator>Lewis, Marquita</creator><creator>Patel, Ashruta</creator><creator>Johnson, Ethel</creator><creator>Clark, Debra</creator><creator>Gamboa, Christopher</creator><creator>Richman, Joshua S</creator><general>American Academy of Family Physicians</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201508</creationdate><title>Peer Coaches to Improve Diabetes Outcomes in Rural Alabama: A Cluster Randomized Trial</title><author>Safford, Monika M ; Andreae, Susan ; Cherrington, Andrea L ; Martin, Michelle Y ; Halanych, Jewell ; Lewis, Marquita ; Patel, Ashruta ; Johnson, Ethel ; Clark, Debra ; Gamboa, Christopher ; Richman, Joshua S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-eb426ba17761a35ab57d166a4b3937e7245ce68bbb14e9457433a92edc8c39a83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Alabama</topic><topic>Blood Pressure</topic><topic>Body Mass Index</topic><topic>Cholesterol, LDL - blood</topic><topic>Cluster Analysis</topic><topic>Counseling - methods</topic><topic>Diabetes Mellitus - blood</topic><topic>Diabetes Mellitus - psychology</topic><topic>Diabetes Mellitus - therapy</topic><topic>Female</topic><topic>Glycated Hemoglobin A - analysis</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original Research</topic><topic>Peer Group</topic><topic>Quality of Life</topic><topic>Rural Population</topic><topic>Self Care - methods</topic><topic>Self Care - psychology</topic><topic>Social Support</topic><topic>Telephone</topic><topic>Treatment Outcome</topic><topic>Vulnerable Populations</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Safford, Monika M</creatorcontrib><creatorcontrib>Andreae, Susan</creatorcontrib><creatorcontrib>Cherrington, Andrea L</creatorcontrib><creatorcontrib>Martin, Michelle Y</creatorcontrib><creatorcontrib>Halanych, Jewell</creatorcontrib><creatorcontrib>Lewis, Marquita</creatorcontrib><creatorcontrib>Patel, Ashruta</creatorcontrib><creatorcontrib>Johnson, Ethel</creatorcontrib><creatorcontrib>Clark, Debra</creatorcontrib><creatorcontrib>Gamboa, Christopher</creatorcontrib><creatorcontrib>Richman, Joshua S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of family medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Safford, Monika M</au><au>Andreae, Susan</au><au>Cherrington, Andrea L</au><au>Martin, Michelle Y</au><au>Halanych, Jewell</au><au>Lewis, Marquita</au><au>Patel, Ashruta</au><au>Johnson, Ethel</au><au>Clark, Debra</au><au>Gamboa, Christopher</au><au>Richman, Joshua S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Peer Coaches to Improve Diabetes Outcomes in Rural Alabama: A Cluster Randomized Trial</atitle><jtitle>Annals of family medicine</jtitle><addtitle>Ann Fam Med</addtitle><date>2015-08</date><risdate>2015</risdate><volume>13 Suppl 1</volume><issue>Suppl_1</issue><spage>S18</spage><epage>S26</epage><pages>S18-S26</pages><issn>1544-1709</issn><eissn>1544-1717</eissn><abstract>It is unclear whether peer coaching is effective in minority populations living with diabetes in hard-to-reach, under-resourced areas such as the rural South. We examined the effect of an innovative peer-coaching intervention plus brief education vs brief education alone on diabetes outcomes.
This was a community-engaged, cluster-randomized, controlled trial with primary care practices and their surrounding communities serving as clusters. The trial enrolled 424 participants, with 360 completing baseline and follow-up data collection (84.9% retention). The primary outcomes were change in glycated hemoglobin (HbA1c), systolic blood pressure (BP), low density lipoprotein cholesterol (LDL-C), body mass index (BMI), and quality of life, with diabetes distress and patient activation as secondary outcomes. Peer coaches were trained for 2 days in community settings; the training emphasized motivational interviewing skills, diabetes basics, and goal setting. All participants received a 1-hour diabetes education class and a personalized diabetes report card at baseline. Intervention arm participants were also paired with peer coaches; the protocol called for telephone interactions weekly for the first 8 weeks, then monthly for a total of 10 months.
Due to real-world constraints, follow-up was protracted, and intervention effects varied over time. The analysis that included the 68% of participants followed up by 15 months showed only a significant increase in patient activation in the intervention group. The analysis that included all participants who eventually completed follow-up revealed that intervention arm participants had significant differences in changes in systolic BP (P = .047), BMI (P = .02), quality of life (P = .003), diabetes distress (P = .004), and patient activation (P = .03), but not in HbA1c (P = .14) or LDL-C (P = .97).
Telephone-delivered peer coaching holds promise to improve health for individuals with diabetes living in under-resourced areas.</abstract><cop>United States</cop><pub>American Academy of Family Physicians</pub><pmid>26304967</pmid><doi>10.1370/afm.1798</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | Annals of family medicine, 2015-08, Vol.13 Suppl 1 (Suppl_1), p.S18-S26 |
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| subjects | Aged Alabama Blood Pressure Body Mass Index Cholesterol, LDL - blood Cluster Analysis Counseling - methods Diabetes Mellitus - blood Diabetes Mellitus - psychology Diabetes Mellitus - therapy Female Glycated Hemoglobin A - analysis Humans Male Middle Aged Original Research Peer Group Quality of Life Rural Population Self Care - methods Self Care - psychology Social Support Telephone Treatment Outcome Vulnerable Populations |
| title | Peer Coaches to Improve Diabetes Outcomes in Rural Alabama: A Cluster Randomized Trial |
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