Self-management of diabetes is essential to reducing the risks of associated
disabilities. But effective self-management is often short-lived. Peers can provide the
kind of ongoing support that is needed for sustained self-management of diabetes. In this
context, peers are nonprofessionals who have diabetes or close familiarity with its
management. Key functions of effective peer support include assistance in daily
management, social and emotional support, linkage to clinical care, and ongoing
availability of support. Using these four functions as a template of peer support, project
teams in Cameroon, South Africa, Thailand, and Uganda developed and then evaluated peer
support interventions for adults with diabetes. Our initial assessment found improvements
in symptom management, diet, blood pressure, body mass index, and blood sugar levels for
many of those taking part in the programs. For policy makers, the broader message is that
by emphasizing the four key peer support functions, diabetes management programs can be
successfully introduced across varied cultural settings and within diverse health
systems.
People seeking to prevent or manage health conditions can be a powerful source of support to each other to manage complex behaviors. Peers for Progress has a defined functional framework for peer support's core functions, and is evaluating the scope and impact of peer support interventions based on this framework and a set of consensus evaluation measures. Peers for Progress looks to raise the visibility and applicability of peer support as good health care for all people.
ObjectivesExamine Peer Support (PS) for complex, sustained health behaviors in prevention or disease management with emphasis on diabetes prevention and management.Data sources and eligibilityPS was defined as emotional, motivational and practical assistance provided by nonprofessionals for complex health behaviors. Initial review examined 65 studies drawn from 1442 abstracts identified through PubMed, published 1/1/2000–7/15/2011. From this search, 24 reviews were also identified. Extension of the search in diabetes identified 30 studies published 1/1/2000–12/31/2015.ResultsIn initial review, 54 of all 65 studies (83.1%) reported significant impacts of PS, 40 (61.5%) reporting between-group differences and another 14 (21.5%) reporting significant within-group changes. Across 19 of 24 reviews providing quantifiable findings, a median of 64.5% of studies reviewed reported significant effects of PS. In extended review of diabetes, 26 of all 30 studies (86.7%) reported significant impacts of PS, 17 (56.7%) reporting between-group differences and another nine (30.0%) reporting significant within-group changes. Among 19 of these 30 reporting HbA1c data, average reduction was 0.76 points. Studies that did not find effects of PS included other sources of support, implementation or methodological problems, lack of acceptance of interventions, poor fit to recipient needs, and possible harm of unmoderated PS.ConclusionsAcross diverse settings, including under-resourced countries and health care systems, PS is effective in improving complex health behaviors in disease prevention and management including in diabetes.Electronic supplementary materialThe online version of this article (doi:10.1186/s40842-017-0042-3) contains supplementary material, which is available to authorized users.
Traditional efforts to translate evidence-based prevention strategies to communities, at scale, have not often produced socially significant outcomes or the local capacity needed to sustain them. A key gap in many efforts is the transformation of community prevention systems to support and sustain local infrastructure for the active implementation, scaling, and continuous improvement of effective prevention strategies. In this paper, we discuss (1) the emergence of applied implementation science as an important type 3–5 translational extension of traditional type 2 translational prevention science, (2) active implementation and scaling functions to support the full and effective use of evidence-based prevention strategies in practice, (3) the organization and alignment of local infrastructure to embed active implementation and scaling functions within community prevention systems, and (4) policy and practice implications for greater social impact and sustainable use of effective prevention strategies.
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