Background The Peers Supporting Health Literacy, Self-efficacy, Self-Advocacy, and Adherence (Peers LEAD) program is a culturally tailored educational-behavioral 8-week intervention that addressed psychosocial and sociocultural barriers to diabetes medication adherence in African Americans. A brief 3-week version of the Peers LEAD intervention used a community engagement approach to examine the feasibility and acceptability of the intervention amongst patient stakeholders. Main body African Americans who were adherent to their diabetes medicines were paired with those who were non-adherent to their medicines. Together, they participated in the group and phone-based medication adherence intervention. Input from this brief intervention was important for the design of the remainder weeks of the 8-week program. The intervention targeted negative beliefs about diabetes, use of diabetes medicines, and offering culturally tailored peer support to improve medication adherence in African Americans. To receive input in the development and implementation of the program, we worked with community advisors and a peer ambassador board of African Americans who were adherent to their diabetes medicines. The peer ambassador board and community advisors reviewed intervention materials to ensure they were understandable and appropriate for the community. As well, they provided feedback on the process for intervention delivery. Conclusion The active engagement of the peer ambassador board and community advisors led to a revised intervention process and materials for a medication adherence program for African Americans with type 2 diabetes.
Objectives: African Americans (AAs) have higher rates of medication nonadherence compared to non-Hispanic whites. In this study, we determined the preliminary feasibility of an 8-week intervention focused on improving culturally-informed illness and medication beliefs, self-efficacy, and medication adherence. Methods: We used purposeful sampling to recruit 8 peer ambassadors (PAs), individuals constituting the advisory board of AAs adherent to their medicines, and 7 peer buddies (PBs), assessed as non-adherent to their diabetes medicines. PAs and PBs were paired. They completed 2 group educational sessions together and one follow-up phone call to PBs by PAs. Results: PAs were mostly female (N = 5, 63%), mean age of 55 years (± 8.3). Similarly, PBs were mostly female (N = 6, 86%), mean age of 56 years (± 6.3). Follow-up interviews with PBs revealed that they liked discussing medication management strategies and diabetes management resources, sharing their diabetes experiences with their PA and connecting with them over the phone. All PBs reported a positive, trusting relationship between them and their PAs. Conclusions: This study demonstrates AAs with diabetes medication adherence challenges are receptive to a peer support mechanism to address culturally informed beliefs and enhance patient-provider communication and self-efficacy.
Health disparities continue to exist in the United States, with the most significant differences occurring between racial groups. Racial health disparities are largely a result of the strong association between race and structural inequities -the systematic differential in the distribution of power, resources, opportunities, and exposures across racial populations. The use of case-based learning is common practice in pharmacy education, with race often included out of convention. In some cases, race is included to inform treatment based on guidelines developed from epidemiological and clinical studies that link race to disease by conferring biological significance to race categories. This continuing use of race/ethnicity to guide treatment contributes to racial health disparities, and may further perpetuate existing provider implicit bias. This paper discusses the pedagogical approach of using patient cases; convention, propriety, and implications of including race in patient cases; and guides pharmacy educators on how to utilize information on race.
African Americans (AAs) with diabetes are more likely to develop diabetes-related complications and have the highest diabetes-related mortality rates, than all other racial/ethnic groups. These health disparities are primarily due to poor medication adherence (defined as not taking medications as prescribed). AAs have substantially lower adherence to diabetes medications than whites, which contributes to higher rates of diabetes-related complications, such as amputations and strokes. There is a critical need to develop diabetes self-management interventions that improve medication adherence, clinical outcomes and in turn reduce morbidity and mortality among AAs with diabetes. Focusing on psychosocial factors such as health beliefs, self-efficacy and patient-provider communication is instrumental to improving AAs medication adherence. To address this need, we developed, the Peers Supporting Health Literacy, Self-Efficacy, Self-Advocacy, and Adherence (Peers LEAD) intervention, which provides AAs with culturally adapted diabetes and medication beliefs information, one-on-one peer support from AAs with diabetes, and communication and self-efficacy skill development to enhance medication adherence. This pilot research is a pre-post single group intervention study design which will be conducted in two phases using a community engaged approach. The objective is to test the Peers LEAD intervention in Phase 1, and then examine specific intervention elements for refinement in Phase 2. We will employ both quantitative and qualitative methods to assess the feasibility, acceptability, and outcomes of Peers LEAD. Building on established community partnerships, we plan to recruit and enroll 30 Peer Buddies and 20 Peer Ambassadors to participate in the intervention. By utilizing patient feedback to refine Peers LEAD and piloting it to examine its feasibility, we will generate evidence regarding its real world use and provide support for a randomized controlled trial of its impact on AAs diabetes medication adherence and clinical outcomes.
In a rapidly changing public health crisis such as COVID-19, researchers need innovative approaches that can effectively link qualitative approaches and computational methods. In this article, computational and qualitative methods are used to analyze survey data collected in March 2020 ( n = 2,270) to explore the content of persuasive messages and their relationship with self-reported health behavior—that is, social distancing. Results suggest that persuasive messages, based on participants’ perspectives, vary by gender and race and are associated with self-reported health behavior. This article illustrates how qualitative analysis and structural topic modeling can be used in synergy in a public health study to understand the public’s perception and behavior related to science issues. Implications for health communication and future research are discussed.
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