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Ann Fam Med. 2015 Aug;13 Suppl 1:S18-26. doi: 10.1370/afm.1798.

Peer Coaches to Improve Diabetes Outcomes in Rural Alabama: A Cluster Randomized Trial.

Author information

1
Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama msafford@uab.edu.
2
Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
3
Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama West Central Alabama Community Health Improvement League, Camden, Alabama.
4
Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama Sumter County Health and Wellness Education Center, Livingston, Alabama.
5
Birmingham VA Medical Center, Birmingham, Alabama Department of Surgery, University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.

Abstract

PURPOSE:

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.

METHODS:

This was a community-engaged, cluster-randomized, controlled trial with primary care practices and their surrounding communities serving as clusters. The trial enrolled 424 participants, with 360 completing baseline and follow-up data collection (84.9% retention). The primary outcomes were change in glycated hemoglobin (HbA1c), systolic blood pressure (BP), low density lipoprotein cholesterol (LDL-C), body mass index (BMI), and quality of life, with diabetes distress and patient activation as secondary outcomes. Peer coaches were trained for 2 days in community settings; the training emphasized motivational interviewing skills, diabetes basics, and goal setting. All participants received a 1-hour diabetes education class and a personalized diabetes report card at baseline. Intervention arm participants were also paired with peer coaches; the protocol called for telephone interactions weekly for the first 8 weeks, then monthly for a total of 10 months.

RESULTS:

Due to real-world constraints, follow-up was protracted, and intervention effects varied over time. The analysis that included the 68% of participants followed up by 15 months showed only a significant increase in patient activation in the intervention group. The analysis that included all participants who eventually completed follow-up revealed that intervention arm participants had significant differences in changes in systolic BP (P = .047), BMI (P = .02), quality of life (P = .003), diabetes distress (P = .004), and patient activation (P = .03), but not in HbA1c (P = .14) or LDL-C (P = .97).

CONCLUSION:

Telephone-delivered peer coaching holds promise to improve health for individuals with diabetes living in under-resourced areas.

KEYWORDS:

Peer health coaching; diabetes; primary care; self-management support

PMID:
26304967
PMCID:
PMC4648138
DOI:
10.1370/afm.1798
[Indexed for MEDLINE]
Free PMC Article

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