Background Health care centers serving low-income communities have scarce resources to support medication decision-making among patients with poorly controlled diabetes. Objective We compared outcomes between community health worker (CHW) use of a tailored, interactive web-based tablet-delivered tool (iDecide) versus use of print educational materials. Design A randomized two-arm trial from 2011-2013. Trial Registration NCT01427660. Setting Community health center in Detroit serving a Latino and African American low-income population. Participants 188 adults with a hemoglobinA1c >7.5% (55%) or who reported questions, concerns, or difficulty taking diabetes medications Primary Funding Sources Agency for Health Care Quality and Research (1R18HS019256-01) and P30DK092926 (MCDTR) Measurements Primary outcomes were changes in knowledge about anti-hyperglycemic medications, patient-reported medication decisional conflict, and satisfaction with anti-hyperglycemic medication information. We also examined changes in diabetes distress, self-efficacy, medication adherence, and A1c. Intervention Participants were randomized to receive a 1-2 hour session with a CHW using either iDecide or printed educational materials and two follow-up calls. Results 94% of participants completed three-month follow-up. Both groups improved across most measures. iDecide participants reported greater improvements in satisfaction with medication information (helpfulness, p=.007; clarity, p=.03) and in diabetes distress compared to the print materials group (p<0.001). There were no differences between groups in other outcomes. Limitations The study was conducted at one health center over a short period, and the CHWs were experienced in behavioral counseling, thus possibly mitigating the need for additional support tools. Conclusions Most outcomes were similarly improved among participants receiving both types of diabetes medication decision-making support. Longer-term evaluations are necessary to determine whether the greater improvements in satisfaction with medication information and diabetes distress achieved in the iDecide group at three months translate into better longer-term diabetes outcomes.

Background Disease management programs for patients hospitalized with heart failure (HF) although effective, are often resource intensive, limiting their uptake. Peer support programs have led to improved outcomes among patients with other chronic conditions and may result in similar improvements for HF patients. Methods and Results In this randomized controlled trial, Reciprocal Peer Support (RSP) arm patients participated in a HF nurse practitioner (NP)-led goal setting group session, received brief training in peer communication skills, and were paired with another participant in their cohort with whom they were encouraged to talk weekly using a telephone platform. Participants were also encouraged to attend three NP-facilitated peer support group sessions. Patients in the Nurse Care Management (NCM) arm attended a NP-led session to address their HF care questions and receive HF educational materials and information on how to access care management services. The median age of the patients was 69 years, 51% were female, and 26% were racial/ethnic minorities. Only 55% of RPS patients participated in peer calls or group sessions. In intention-to-treat analyses, the RPS and NCM groups did not differ in time to first all-cause rehospitalization or death or in mean numbers of rehospitalizations or deaths. There were no differences in improvements in 6-month measures of HF-specific quality of life or social support. Conclusions Among patients recently hospitalized for HF, over half of RPS participants had no or minimal engagement with the reciprocal peer support program, and the program did not improve outcomes compared to usual HF-nurse care management.

Background Together, community-based participatory research (CBPR), usercentered design (UCD) and health information technology (HIT) offer promising approaches to improve health disparities in low-resource settings. Objectives This article describes the application of CBPR and UCD principles to the development of iDecide/Decido, an interactive, tailored, web-based diabetes medication education and decision support tool delivered by community health workers (CHWs) to African-American and Latino participants with diabetes in Southwest and Eastside Detroit. The decision aid is offered in English or Spanish and is delivered on an iPad in participants’ homes. Methods The overlapping principles of CBPR and UCD used to develop iDecide/Decido include: a user-focused or community approach; equitable academic and community partnership in all study phases; an iterative development process that relies on input from all stakeholders; and a program experience that is specified, adapted, and implemented with the target community. Results Collaboration between community members, researchers, and developers is especially evident in the program’s design concept, animations, pictographs, issue cards, goal setting, tailoring, and additional CHW tools. Conclusions Applying the principles of CBPR and UCD can be successfully employed in developing health information tools that are easy to use and understand, interactive, and target health disparities.

Purpose-This study's purpose is 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 webbased tool (iDecide) was compared with peer coaches with no access to the tool. 290 Veterans Affairs patients with A1c>8.0% received a six-month intervention with an initial session with a fellow patient trained to be a peer coach followed by weekly phone calls to discuss behavioral