TY - JOUR
T1 - Peer coaches to improve diabetes outcomes in rural Alabama
T2 - A cluster randomized trial
AU - Safford, Monika M.
AU - Andreae, Susan
AU - Cherrington, Andrea L.
AU - Martin, Michelle Y.
AU - Halanych, Jewell
AU - Lewis, Marquita
AU - Patel, Ashruta
AU - Johnson, Ethel
AU - Clark, Debra
AU - Gamboa, Christopher
AU - Richman, Joshua S.
N1 - Publisher Copyright:
© 2015, Annals of Family Medicine, Inc. All rights reserved.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - PURPOSE 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. METHODS 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. RESULTS 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). CONCLUSION Telephone-delivered peer coaching holds promise to improve health for individuals with diabetes living in under-resourced areas.
AB - PURPOSE 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. METHODS 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. RESULTS 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). CONCLUSION Telephone-delivered peer coaching holds promise to improve health for individuals with diabetes living in under-resourced areas.
KW - Diabetes
KW - Peer health coaching
KW - Primary care
KW - Self-management support
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U2 - 10.1370/afm.1798
DO - 10.1370/afm.1798
M3 - Article
C2 - 26304967
AN - SCOPUS:84982218456
SN - 1544-1709
VL - 13
SP - S18-S26
JO - Annals of family medicine
JF - Annals of family medicine
ER -