ENCOURAGE: Evaluating Community Peer Advisors and Diabetes Outcomes in Rural Alabama

Not Applicable

Completed

Brief Summary: It is unclear whether peer coaching is effective in minority populations living with diabetes in hard-to-reach, under resourced areas such as the rural South. We examined the effect of an innovative peer coaching intervention plus brief education vs. brief education alone on diabetes outcomes.

Detailed Description: The purpose of this project was to provide robust evidence on the effectiveness of a peer support intervention in improving diabetes outcomes by conducting a group-randomized, controlled implementation trial of a volunteer peer support intervention.

The study had three specific aims:

Aim 1. In Phase I (months 0-8), to perform a qualitative needs assessment with peer advisors and health care providers to inform peer advisor roles and responsibilities (i.e., the intervention) and peer advisor recruitment strategies, curriculum and training; and patient recruitment plans.

Aim 2. Also in Phase I, to pilot our collaboratively developed intervention and, based on pilot test results, to recruit and train peer advisors for the intervention, and begin patient recruitment.

Aim 3. In Phase II (months 9-32), conduct the group randomized implementation trial and evaluate it using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

not community dwelling, less than 19 years old, pregnant, end-stage medical conditions with limited life expectancy, no access to telephone, does not speak english

Arm && Interventions

Group	Intervention	Description
Encourage study	ENCOURAGE Study	Participants in the intervention arm were paired with a peer coach, interacting by telephone weekly for the first 8 weeks and then monthly for a total of 10 months. Participants also received 1-hour group diabetes education class covering diabetes basics, healthy eating, stress reduction, physical activity, social support, and how to get the most out of their doctors visit. Participants also received a diabetes report card showing their Hba1c, blood pressure, ldl cholesterol, and body weight.

Primary Outcome Measures

Name	Time	Method
LDL cholesterol	Change in LDL cholesterol in 12 month	measured using finger stick, spectrophotometer to measure LDL cholesterol
depressive symptoms	change in depressive symptoms at 12 months	self-report using Patient Health Questionnaire 8 (PHQ8)
Glycated hemoglobin (A1c)	Change in A1c in 12 months	fingerstick, point-of-care a1c test
Blood pressure	Change in blood pressure measure in 12 months	Measured using digital automated blood pressure monitor
diabetes self-care behaviors questionnaire	Change in diabetes self-care behaviors at 12 months	aspects of diabetes self-management such as taking medications as directed, self-report of exercise, and eating behaviors
patient activation	change in patient activation in 12 months	self-report using the 13 item Patient Activation Measure (PAM13)
quality of life	Change in quality of life measures at 12 months	self-report using Short form-1 (SF1), and Euroquol (EQ-5D)

Secondary Outcome Measures

Name	Time	Method
body mass index	change in BMI in 12 months	weight measured using digital scale, height measured using stadiometer
composite measure of healthcare utilization	Change in health care utilization in 12 months	self-report by participant, number of times utilized healthcare services
diabetes knowledge	change in diabetes knowledge in 12 months	assessed using the Spoken Knowledge in Low Literacy in Diabetes Scale
trust in physicians	change in trust in physicians in 12 months	assessed using the Trust in Physicians Scale