Healthcare providers can help improve communication with these women by actively seeking to meet their support needs and educating families so that provisional support is more meaningful and diabetes management more attainable.

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The African American church is held in the highest esteem by most African Americans. Although the influence of the African American church has been underestimated by physicians and nurses, it could be pivotal in optimizing health status among African Americans. Because of this influence, health care practitioners, including nurses, are now recognizing the important role that the African American church plays in improving the health status of individuals in the African American community. This article illuminates the health and health care concerns of the African American community by considering the traditional lack of equal access for this population and the role that the church can play in not only offering church-based health care services but also improving the health status of church congregations. Future roles of the African American church for improved health status are also suggested.

The purpose of this paper was to report findings from an integrative literature review conducted to identify the theoretical basis of interventions for studies using community health advisors; populations and settings served by community health advisors; characteristics, training, and roles and activities of community health advisors; and the effectiveness of interventions by community health advisors for improving self-management of patients living with type 2 diabetes mellitus. Community health advisors' theoretical interventions were based on providing culturally appropriate care and resolution of health disparities within minority populations. Typically community health advisors were patients themselves living with type 2 diabetes mellitus. Major roles of community health advisors included: supporter, educator, case manager, advocate, and program facilitator. Activities of community health advisors were: coordinating educational programs, conducting educational courses for patients, serving as a link between patients and healthcare professionals, providing counseling, and leading peer support meetings. The effectiveness of interventions by community health advisors was mixed. Examples of outcome criteria were improvements in: knowledge, hemoglobin A1C, low density lipoprotein levels, blood pressure, and physical activity. Community health advisors provide culturally appropriate interventions to promote and restore health and prevent diseases while serving as links between community and healthcare providers.

IntroductionPeer support is a promising strategy for the reduction of diabetes-related health disparities; however, few studies describe the development of such strategies in enough detail to allow for replication. The objective of this article is to describe the development of a 1-year peer support intervention to improve diabetes self-management among African American adults with diabetes in Alabama's Black Belt.MethodsWe used principles of intervention mapping, including literature review, interviews with key informants, and a discussion group with community health workers, to guide intervention development. Qualitative data were combined with behavioral constructs and principles of diabetes self-management to create a peer support intervention to be delivered by trained peer advisors. Feedback from a 1-month pilot was used to modify the training and intervention.ResultsThe resulting intervention includes a 2-day training for peer advisors, who were each paired with 3 to 6 clients. A one-on-one in-person needs assessment begins an intensive intervention phase conducted via telephone for 8 to 12 weeks, followed by a maintenance phase of at least once monthly contacts for the remainder of the intervention period. A peer support network and process measures collected monthly throughout the study supplement formal data collection points at baseline, 6 months, and 12 months.DiscussionIntervention mapping provided a useful framework for the development of culturally relevant diabetes peer support intervention for African Americans living in Alabama's Black Belt. The process described could be implemented by others in public health to develop or adapt programs suitable for their particular community or context.

Women with the least education had the highest CV Risk-Index, regardless of race. These findings suggest the need to focus risk reduction interventions on all Southern rural women with limited education, not only African American women. This supports the current literature that suggests race should be viewed as a risk marker rather than a risk factor.