Social Networks-Based Diabetes Education Improves Social Efficacy And Cohesion, And Favors Sustainability

Abstract

OBJECTIVES: Diabetes group education programs have shown better clinical outcomes than one-on-one programs. That effect often subsides when the program is discontinued. We explore the impact of a novel intervention, in a largely African-American population with diabetes. We assess the impact of leveraging patients' natural social networks on measures of social efficacy and cohesion, with the assumption that those variables will support behavior change and mitigate modifiable risk factors. METHODS: Intervention patients (P2P ®) were asked to recruit peers, form small clusters, and attended monthly diabetes education sessions. Control patients were recruited, educated and followed up individually. P2P ® patients engaged in interactive educational sessions within their cluster. HbA1c, blood glucose, functional status (SF-12), self-efficacy (General Self-Efficacy Scale), cohesion (Perceived Cohesion Scale), social network characteristics (Social Network Index), and disease knowledge (Diabetes Knowledge Test) were recorded at baseline and followed up at 3-months. RESULTS: Among the 136 patients recruited in the study, intervention patients' (68) scores were lower on the number of active social network domains (1.1 vs.1.4, P=0.09), network diversity (5.6 vs. 5.9, P=0.30), and number of people in network (11.0 vs. 12.3, P=0.21) than controls (68), at baseline. Other baseline characteristics were evenly distributed between arms. After 3 months of followup, the intervention group had a statistically significantly greater increase in values for active social network domains (1.1, P<0.01), diversity (4.52, P<0.01), and contacts (0.84, P<0.01) than the control group. At the second follow-up, (only 22 patients have reached that point so far) social network index values improved even further from baseline (3.1, 10.8, and 1.0, respectively), compared to the controls. CONCLUSIONS: The P2P ® social networks intervention is showing improved social efficacy and integration of patients within their existing networks. These results inform the translation of diabetes education to a sustainable diabetes self-management behavior at the community level.