Puentes hacia una mejor vida (Bridges to a Better Life): Outcome of a Diabetes Control Peer Support Intervention

Abstract

PURPOSE Peer support can promote diabetes control, yet research on feasible and effective peer support models is lacking. This randomized controlled trial tested a volunteer-based model of peer support for diabetes control.METHODS Thirty-four volunteer peer leaders were recruited and trained to provide support to 5 to 8 patients each through telephone contact, in-person, individual, and group support. Planned dose was 8 contacts, preferably in the first 6 months. Patients with uncontrolled diabetes were randomly sampled from the medical records of 3 community clinics. After a baseline interview and medical records review to obtain baseline values for the primary outcome, HbA 1c , 336 patient participants were randomly assigned to a 12-month peer support intervention or usual care. The assessment protocol was repeated at 6 and 12 months after baseline. RESULTSThirty peer leaders delivered an average of 4 contacts each per assigned participant (range 1-24). Despite the lack of intervention fidelity, the intervention was effective at reducing glycated hemoglobin (HbA 1c ) among intervention as compared with usual care participants (P=0.05). Similar trends were observed in frequency of meeting fruit and vegetable guidelines (P =0.09), a secondary outcome. Counterintuitively, usual care participants reported checking their feet more days out of 7 than intervention participants (P =0.03).CONCLUSIONS Given the modest changes we observed, combined with other evidence for peer support to promote diabetes control, additional research is needed on how to modify the system of care to increase the level of peer support delivered by volunteers.Ann Fam Med 2015;13(Suppl_1):S9-S17. doi: 10.1370/afm.1807. States (9.3% in 2012). 1 Rates are higher among Mexican-Americans (13.9%), among those who live near the US-Mexico border (14.7% on the US side, for instance) 2 and among residents of rural areas. INTRODUCTION D iabetes is prevalent in the United3 Health care use remains low in rural border communities, 4,5 and health care is underused for managing diabetes. 6,7 Research is needed on how to promote glycemic control in rural border communities.Controlling diabetes requires engaging in healthy behaviors such as exercise, self-monitoring, controlling symptoms, and using medication and health care properly. 8 An educator, potentially a peer leader, 9,10 can help persons with diabetes develop the necessary skills to make these behaviors part of their daily lives. In Latino and other racial/ethnic and low-income communities, community health workers (CHWs) often serve as educators and peer leaders, facilitating access to health care, training in selfmanagement behaviors, and providing emotional support. 9,[11][12][13][14][15][16][17][18][19] CHWs are typically members of the communities they serve and have direct or indirect experience with the health issue of interest.11 Most CHW interventions with Latinos to promote diabetes control have involved paid CHWs serving in various roles within a health care system or a community-...

Relationship between social support networks and diabetes control and its impact on the quality of life in older community-dwelling Mexicans

“…The results suggest that the difference is the effect of the participation of older adults in community health promotion programs where they receive self-care training to adopt healthy lifestyles and help to strengthen mutual adherence. In this sense, it has been shown that community work and peer support has a positive effect on improving the self-care and health status of adults and older adults (24)(25)(26).…”

Peer Support Interventions for Adults With Diabetes: A Meta-Analysis of Hemoglobin A1c Outcomes

“…21,26,27,30,37 In contrast, the pooled effect size from the 7 studies with predominantly white, non-Hispanic participants showed no improvement in HbA 1c level with peer support interventions, with an SMD of -0.004 (95% CI, -0.153 to 0.144; P = .95; I 2 = 59.41%). 22,25,29,[31][32][33][34] The pooled effect in the subgroup of 3 studies with predominantly African American participants showed a similar effect size to that seen in the Hispanic subgroup but was not statistically significant, with an SMD of 0.25 (95% CI, -0.064 to 0.571; P = .11; I 2 = 58.60%).…”

“…20 Ultimately, 14 articles with RCT designs and 3 cluster RCTs were eligible for inclusion in the meta-analysis, for a total of 4,715 participants. Of the 17 trials, 10 were done in the United States, [21][22][23][24][25][26][27][28][29][30] …”

“…In all but 4 of the 17 trials (23.5%), the dropout rate was less than 20%. 21,27,33,35 None of the trials blinded participants, but 3 trials (17%) blinded outcomes assessors or investigators. Allocation concealment was not reported in 3 studies and not done in 1 study.…”

New directions for diabetes prevention and management in behavioral medicine

“…Peer support and coaching may offer particular benefits in areas in which health care resources and provider access are lacking. This approach to shared decision making has demonstrated feasibility in varied cultures and settings (Ayala et al, 2015; Safford et al, 2015; Zhong et al, 2015). The World Health Organization has noted that standard features of peer support may be used cross culturally and individual programs can use these features in the development of interventions that best fit the cultures, populations and health systems in which they function (Fisher et al, 2015a).…”