Alliance to Control Diabetes/Alianza para

Controlar la Diabetes
Organization: San Diego State University and Clinicas de Salud del Pueblo

Principal Investigators: Guadalupe X. Ayala, PhD, MPH and John P. Elder, PhD, MPH
Other Investigators and Key Personnel: Andrea Cherrington, MD, MPH, Nadia Campbell,
MPH, Mark Snyder, PhD, Afshan N. Baig, MD, Ming Ji, PhD, Leticia Ibarra, MPH

Audience and Setting

 U.S.-Mexico border in California, southern end of agricultural belt

 Adult Mexicans/Mexican-Americans; 23% live in poverty
 336 patients randomly sampled from Clinicas roster

Approaches to Implementing Peer Support

 30 Peer Supporters: former participants in a diabetes

education program; seen as exhibiting mastery over
diabetes; qualities of empathy, warmth, and referent power
 Recruitment/Retention Innovation:
 2 different recruitment letters to be sent October 2009
 Test two messages to recruit and retain Peer Supporters: Community navigation
Facilitate access to
Health care system
self vs. other oriented external resources
(library, internet)
navigation

 6 Training Sessions: 2 full-day on weekend, 4 shorter Problem-solve

overcome social and
Meet with patient
before provider visit
to activate = improve
Home navigation
Family support and Diabetes
sessions on weekdays to begin November 2009; total 32- physical barriers
(celebrations with
communication
engagement control
Healthy control of the
40 hours family, friends and co-
workers; restaurant
Facilitate utilization
of diabetes
social and physical


environments of the home
eating; unsafe management
Peer Supporter assigned to 6 patients with diabetes: neighborhoods) resources Skill building

 Goal: Help improve diabetes self-management behaviors

relevant in multiple contexts (clinic, community, home)
 Dose: Minimum of 8 contacts in first 6 months; less Targets for change in a diabetes peer support intervention
frequent contact in subsequent 6 months Modes of delivery include: family home visits, small group and clinic tours

 Modes: Family home visits, small groups, and clinic tours

Design and Methods Randomly sample 336 patients from

clinic roster & conduct baseline

 Randomized controlled trial with two conditions: peer support vs. Randomly assign to condition
usual care
 Data to be collected at baseline, 6 months, and 12 months
 Measures from medical records: HbA1C, BMI, BP, cholesterol, age Intervention (n=168)
6 months of peer support
of diabetes diagnosis, diabetes medications, hospitalizations, last Each peer supporter assigned to 6
Usual care (n=168)
eye and foot exams, other diagnosed medical conditions adults with diabetes.

 Measures from survey: medication use/adherence, health care

access, health literacy, diabetes self-care, quality of life,
acculturation, demographics, other health behaviors
 Process Evaluation to assess: participant engagement, nature of Follow-up assessments at
6- and 12-months
volunteer peer supporters in Latino community, study design using
RE-AIM model

A program of the American Academy of Family

Physicians Foundation and supported by the Eli
Lilly and Company Foundation, Inc.
 Peer Collaboration in Diabetes Care –
PEERSDIACARE – Cameroon
Organization: Centre for Population Studies and Health Promotion

Investigators: Paschal Kum Awah, PhD and Andre-Pascal Kengne, MD, PhD

Study aims: To identify and create enabling environments for peer support between people with
diabetes, families, and healthcare providers in rural and urban Cameroon

Audience and Setting Preliminary results

 People with diabetes in rural (Bafut) and urban (Bamenda)

health districts of Cameroon Men
Women 43%
 Peer supporters will be recruited from health care providers 57%
caring for people with diabetes and from people with diabetes
themselves
 People with diabetes (PWD) will be recruited though diabetes
clinics; Bafut has three clinics and 80 diabetes patients; 59
58.6
Bamenda has six diabetes clinics and 613 diabetes patients
58.5
Mean age (years)
58
57.7
57.5
57
Approaches to Implementing Peer Support 57

56.5

 Study based in social ecological model to inform an 56

intervention with when, why, and how people engage in peer Men Women Overall
support (social ecology of health behaviors and triggers for
peer support) Mean BMI by visit (kg/m2)
31
 The project will identify peer support devices for use by 30
29.9

29 28.5
people with diabetes and their peers (e.g., email, text
28
messaging, telephone), train peers in the use of them, and 27 26.5
enable peers to interact amongst themselves using 26
networking 25
24
 PWD will serve as the first contact with their peers who do Visit 1 Visit 2 Visit 3
not attend clinics
Mean FBG by visit (mg/dl)
 Other activities will include promoting peer support programs, 185
encouraging networking among those active in peer support 180.5
programs, hosting a webpage to circulate program materials 180
176.1
and curricula 175
170.7
170

STUDY: Design and Methods 165

Visit 1 Visit 2 Visit 3
 80 people with diabetes and 80 as their peers (one per
patient)
160
 All participants allocated to intervention group; outcomes
140
138 142 141
compared between urban and rural participants (repeated
measures; participants serve as own control) 120
100
 Anthropometric, risk factor, biological, behavioral,
80
81 82 83

psychosocial wellbeing, self care, compliance, and quality of

life data 60
Mean SBP by visit (mmHG)
40
 Baseline, mid-duration, and end-of-project evaluations (20-
20
Mean DBP by visit (mmHG)
month study period)
0
Visit 1 Visit 2 Visit 3

A program of the American Academy of Family

Physicians Foundation and supported by the Eli
Lilly and Company Foundation, Inc.
 Peer Coaching for Low-Income Patients with
Diabetes in Primary Care
Organization: University of California at San Francisco, Department of Family and
Community Medicine

Investigators: Thomas Bodenheimer, MD, MPH, David Thom, MD, PhD,

Ellen Chen, MD, Amireh Ghorob, MPH

Audience and Setting

Study Flow Chart
 400 low income English and Spanish-speaking patients with type 2 Months
diabetes and HbA1C >8% recruited from 4 community health clinics Recruit clinics; identify, enroll
in San Francisco, California 1-8 and train health coaches;

 Potential peer coaches (patients with diabetes, HbA1c <8.5%)

Identify patients

identified by clinic staff

 40 peer coaches to be recruited by October 2009
Recruit patients;
9-12 Administer
baseline surveys
Approaches to Implementing Peer Support (N=200)

 Peer coaches to be trained in 2-3 hour sessions each week for 6

weeks during November and December 2009
 Peer coach training materials piloted with community health
9-18
Intervention
(peer coach)
Control
(usual care)
workers at San Francisco General Hospital; materials currently
(N=200) (N=200)
being translated into Spanish
 Peer coaches will be trained to support daily management of
diabetes, adherence to treatment plans, appointment and lab
reminders, social and emotional support, navigating the clinic, and
linking patients to community resources. End of
 Each peer coach will be assigned 5-6 patients with diabetes 15-24
intervention:
Administer 6
Administer 6
month surveys
 Over 6 months, peer coach will meet with each patient at least 2 month surveys
times, call at least once every 2 weeks, accompany patient to 1
clinic visit, and attend a monthly meeting for coaches

3 months post-
Design and Methods 18-27 intervention: Administer 9
Administer 9 month surveys
month surveys
 Aim: To improve diabetes outcomes through peer coaching
 Design: RCT of peer coaching vs. usual care
 Sample size: 200 patients in each arm
28-29 Data checking and analysis
 Primary Outcomes: diabetes self-care activities; medication
adherence; missed appointments; emergency room visits and
hospitalizations; quality of life; and HbA1C.
 Secondary Outcomes: diabetes self-efficacy, shared decision-
making; functional status; LDL levels; BMI; and BP 30-32 Writing and Publication

 Outcomes measured at baseline, 6 months, and 12 months for

both patients and peer coaches

A program of the American Academy of Family

Physicians Foundation and supported by the Eli
Lilly and Company Foundation, Inc.
 Peer Support, Empowerment And Remote Communication
Linked by Information Technology (PEARL):
A Multi-Component Program to Improve Community-Based Diabetes Care

Organization: Asia Diabetes Foundation and Hong Kong Institute of Diabetes and Obesity,
The Chinese University of Hong Kong, Hong Kong SAR, CHINA
Principal Investigator: Juliana C. N. Chan, MD, FRCP
Co-Investigators: Gary T.C. Ko, MD FRCP, Rebecca Y.M. Wong, RN MA, Shimen Au, RN, Lancelot Mui, BSc, MPH,
Eva Kan, RN MPH, Alice P.S. Kong, MBChB, FRCP, Ronald C.W. Ma, MB, BChir, MRCP, Peter C.Y. Tong, PhD FRCP,
Joseph Lau, MSc, PhD, Brian Oldenburg, PhD, Robert H. Friedman, MD, Wingyee So, MD FRCP.

Audience and Setting

 People with diabetes (PWD) in Hong Kong, SAR, CHINA

 Patients receiving structured care augmented by a web-based
disease management program enrolled in the Joint Asia Diabetes
Evaluation Program (JADE)

Approaches to Implementing Peer Support

 Motivated and knowledgeable peer leaders will undergo a 32-hour

‘Train the trainer’ program (4 workshops, 8-hours each) for further
empowerment and development of leadership skills
 Supported by a program manager, peer leaders will maintain regular
contact with their assigned mentees in the intervention group
through phone calls, sharing sessions and other forms of
telecommunications
 Peer leaders will encourage their peers to use the Telephone Linked
Care (TLC) automated system for knowledge enhancement and
motivational support
 Each peer leader will contact their mentees (10 per mentor) twice
per month by 15-20 minute phone calls for 3 months
 After 3 months, peer leaders will call their mentees between clinic
visits or more often, if needed

Design and Methods

 Aim: To use peer support and information technology to facilitate

care providers to implement structured care and empower PWD to
acquire self-management skills and improve quality of care
 A 12-month, multi-center, randomized, parallel study involving 600
PWD receiving structured care through the JADE program, with half
of them randomized to receive peer support (n=300)
 Primary outcomes – HbA1c, BP, body weight and lipid profile
 Secondary outcomes – Cognitive-psychological-behavioral
measures using Chinese validated questionnaires:
 Mental Health (Depression Anxiety and Stress Scale (DASS21)
 Self-efficacy (Diabetes Empowerment Scale (C-DES)
 Diabetes Self Care Activities (SDSCA)
 User acceptability and cost-effectiveness of programs

A program of the American Academy of Family

Physicians Foundation and supported by the Eli
Lilly and Company Foundation, Inc.
 Optimizing Diabetes Outcomes: The Role of Peers

Organization: National Research Council of Argentina (CONICET) with the CENEXA. Centre of
Experimental and Applied Endocrinology (UNLP-CONICET),
PAHO/WHO Collaborating Centre for Diabetes (ARGENTINA)

Principal Investigator: Juan Jose Gagliardino, MD

Other Investigators: Charles Clark Jr., MD and Kate Lorig, DrPH

Study aims:
To compare the benefits of a diabetes education program with peers as part of the education team, for
the provision of ongoing psychological and practical support in an 18-month pilot trial.

Audience and Setting

People with type 2 diabetes from La Plata city (Argentina)

Recruitment and Selection:
Physicians and patients from a local primary care institution;
Peers from our team based upon good diabetes control,
motivation, communication skills and interest.

Approaches to Implementing Peer Support

Peers addressing diabetes education, provision of emotional support, solving of daily self-care problems.
Peers will have scheduled contacts with supportees and members of education team:
bimonthly encounters at buffet restaurant with a nutritionist (food selection and meal plan);
weekly (first 6 months), biweekly (next 3 months) and monthly (remaining study period) telephone
communications to assess patients’ problems and clinical, metabolic and psychological progress;
monthly group teleconference (peer plus supportees) (telephone company contract for cell phone
provision and discount rates).

STUDY: Design and Methods

Knowledge
(solve problems)

Randomly selected patients allocated into 2 groups (94 people

Skills Motivation
each; 6 months). Follow-up: 12-months. (self-care (sustained healthy
Patient education courses: 4 small interactive group weekly practices) behaviour)
Empowerment
sessions (2 h each), including knowledge, skills and attitudes;
reinforcement session at 6 months. Improved diabetes control
 Peer support group: patients attend the education courses and
receive peer support. Better quality of life

Evaluation
 A1C changes will be the primary outcome variable; it was used to estimate sample size.
QUALIDIAB data set (clinical, metabolic, therapeutic and economic data; complications) (0-12 months)
 Abbreviated QUALIDIAB data collection at 6 months;
 WHO-5 and patient and peer satisfaction (SF-8 questionnaire) at 6 months.
Statistical analyses: test and chi2 for continuous and categorical data, respectively.

A program of the American Academy of Family

Physicians Foundation and supported by the Eli
Lilly and Company Foundation, Inc.
 Evaluating the Implementation and Effectiveness
of a Diabetes Peer Mentoring Program
Organization: The American Academy of Family Physicians National Research Network (with
Latino Health Access, LA Net, and WellMed Medical Group)

Principal Investigator: Lyndee Knox

Co-Investigators: America Bracho, MD, Deborah Graham, MSPH, MPH, Jessica Huff, Patricia
Cantero, PhD, Margie Gomez, Michelle Henry, MSN

Audience and Setting

 Insured middle-class patient population in San Antonio, TX

 Mentors and mentees are patients recruited from 15 practices
within WellMed
 Recruitment strategies include: electronic reminders to physicians,
referrals, informational pamphlets, posters, word of mouth, and
mailings

Approaches to Implementing Peer Support

 Adapting a successful Diabetes Peer Mentoring Program, Carpeta Roja (CR), from low income, uninsured
population to middle-class population
 Mentors receiving formal training and drawing on their own experiences will provide support to mentees
through in-person meeting, telephone, and other communication
 Mentors will work with 1-5 mentees at a time for 3-14 months, depending on patient need and will complete
an 8-week self-management course prior to beginning mentoring phase

Design and Methods

 Practice-level randomized controlled trial and multiple start date, wait list design. 3 arms: Usual care, 101
course only, 101 plus CR. Outcomes for mentees and mentors assessed.
 Assessing reach by tracking number of patients assessed as eligible, the number who sign-up for mentoring,
and the number who receive mentoring
 Diabetes Distress Scale, EQ-5D for quality of life, and Perceived Diabetes Self-Management Scale
 HbA1c, blood pressure and LDL
 Implementation/process: Recruitment strategies, retention, adaption for senior patient population, adaption for
well resourced healthcare setting, adaption for diverse SES and ethnic background

A program of the American Academy of Family

Physicians Foundation and supported by the Eli
Lilly and Company Foundation, Inc.
 A Peer Champion Program for Ugandan
Adults with Diabetes
Organization: The University of Wisconsin-Madison School of Nursing (USA); and
Mulago Hospital, Department of Medicine, Kampala and Mityana District Hospital,
Mityana (UGANDA)

Principal Investigator: Linda C. Baumann, PhD, RN

Other Investigators: Agatha Nambuya, MD, Fred Nakwagala, MD, MS, and
Josephine Ejang, RN (Mulago Hospital Department of Medicine)

Study Aims/Questions: To test the feasibility and short-term impact of a peer champion program for
adults with type 2 diabetes in the community of Mityana, Uganda

Audience and Setting

 Peer champions and partners were recruited by a

nurse at the Mityana Diabetes Clinic
 In May 2009, 19 champions attended first meeting
 Champions were matched with 27 partners in the
same age group and gender, and in close living
proximity

Approaches to Implementing Peer Support

 Training for champions conducted in English using the Champion Diabetes Guidebook
 Initial peer meeting held in May 2009 (27 attendees) and booster sessions were held in July and August
(34 attendees)
 Community meetings educated participants on diabetes and emotional and psychosocial issues that
may arise, and trained champions in communication skills
 All participants and health care providers were given cell phones using a closed network to maintain
regular contact between peers and providers without airtime charges
 Champions made contact with partners at least once per week over 3 months
 A meeting was held in September 2009 to obtain feedback about the program and post-measures from
all participants

STUDY: Design and Methods

 Pre-test post-test design of a 12-week pilot intervention

 Measures included a self-administered questionnaire, HbA1c, blood pressure, and BMI
 Mityana Clinic Nurse kept a log of all champion-partner contacts
 Cell phone records to track usage among champions, partners, and health care providers

A program of the American Academy of Family

Physicians Foundation and supported by the Eli
Lilly and Company Foundation, Inc.
 Pilot study of a community-based peer support
intervention to improve diabetes self-management
outcomes in Cameroon
Organization: Health of Populations in Transition (HoPiT) Research Group

Principal Investigator: Jean Claude Mbanya, MD, PhD, FRCP

Other Investigators: Eugene Sobngwi, MD, PhD; Felix Assah, MD, MPhil; Leopold
Fezeu, MD, PhD
to provide proof of concept and feasibility of the effectiveness of implementing a community-based multilevel peer support intervention to usual diabetes
care on measures of metabolic control (HbA1c, blood pressure, blood lipids), self management behaviors, and quality of life of diabetes patients in
Cameroon.

Audience and Setting

 People with diabetes (PWD) in the community in Yaoundé, Cameroon

 All enrolled participants are diabetes patients being followed-up at the
diabetes clinic of the National Obesity Centre
 Potential peer supporters recruited for training based on health care
provider recommendation, area of residence, cultural background, and
success in controlling diabetes
 10 Peer Supporters selected after completion of training based on HbA1c Peer support group meet to discuss
<7% and ability to communicate and interact with others healthy cooking of local foods

Approaches to Implementing Peer Support

 2-day peer supporter training emphasized assistance with self-management

behaviors and communication skills
 Peer supporters matched to PWD based on tribe, profession, religion, or
area of residence
 Each peer supporter facilitates a peer support group consisting of 10
members. Currently there are 100 PWD
 Currently all 10 support groups are meeting monthly Peer supporter meets with PWD and her carers

 Peer supporters will meet monthly with their groups and 5 times per month
at home to discuss self-management behaviours

with individuals over the course of 6 months

Socio-
Professional
Group 1
STUDY: Design and Methods
Residence Residence PWD
Zone 1 Zone 2

 Pre-test post-test 6 month pilot study Socio-

Professional
 Standardized questionnaires used: Diabetes Self-Care Activities Group 2
(SDSCA) and Diabetes Quality of Life
 Quantitative measures: HbA1c, blood pressure, blood lipids Peer
Supporters

Organization of peer support

A program of the American Academy of Family

Physicians Foundation and supported by the Eli
Lilly and Company Foundation, Inc.
 A controlled evaluation of the Australasian Peer
for Progress Diabetes Program (PfP-DP) and its
Transferability to Other Countries

Organization: Monash University, School of Public Health & Preventive Medicine

Principal Investigator: Brian Oldenburg, PhD
Co-Investigators: James A. Dunbar and Prasuna Reddy (Flinders and Deakin Universities,
Australia); Dr. Ralph Audehm and Greg Johnson (Diabetes Australia-Victoria, Australia);
Rob Carter (Deakin University, Australia); Maximilian de Courten and Rory Wolfe (Monash
University, Australia); Dr. Pilvikki Absetz (National Institute of Public Health, Finland);
Anuar Zaini (Monash University Malaysia)

Audience and Setting

 People living with Type 2 diabetes in the state of Victoria, Australia

 Participants selected from people with Type 2 diabetes who are registered on the database of Diabetes
Australia-Victoria (non-governmental organization)
 At least 20 peers selected as peer supporters based on personal characteristics (e.g., acceptance of diverse
views)
 Participants ages 25-75 with diabetes at least 12-months

Approaches to Implementing Peer Support

 Lay peer supporters/group facilitators will complete three-days of training to acquire group facilitation,
communication and other basic skills aimed at helping the group members to achieve the desired individual
and group health and social outcomes of the Peers for Progress – Diabetes Program.
 One group leader per 8-15 people with diabetes to encourage behavioral change, build problem solving,
risk assessment and communication skills, assist participants to access to local resources, provide a venue
for informal information exchange and feedback,
 12-monthly peer-led sessions in participants’ local communities over 12 months; sessions address
behavior change, chronic disease self-management, emotional, appraisal, and informational support;
supported by workbook of content and resources

Design and Methods

 Evaluate efficacy of peer support intervention and its transferability to other settings, populations, and
countries
 Participants will be clustered by region and these groups randomly assigned to intervention or waitlist
control arms
 Create 32 groups of 8-15 people with diabetes (16 groups to each arm with at least 99 participants in each
arm)
 Reach and engagement of intended audience per RE-AIM
 Measuring outcomes (HbA1c, BMI. behaviors, quality of life, psychosocial, group effectiveness, and system
outcomes), implementation, and comprehensive economic evaluation
 Measurement at baseline, 6, 12, and 18 months

A program of the American Academy of Family

Physicians Foundation and supported by the Eli
Lilly and Company Foundation, Inc.
 Peer-led self management support in “real
world” clinical and community settings

Organization: University of Michigan Medical School, Department of Medical Education and

Department of Internal Medicine, and the University of Michigan School of Public Health,
Department of Health Behavior and Health Education
Principal Investigators: Tricia S. Tang, PhD and Michele Heisler, MD, MPA
Co-Investigators: Robert Anderson, MEd, EdD; Martha Funnell, MS, RN, CDE; John Piette,
PhD; Michael Spencer, MSW, PhD; Felix Valbuena, MD (Community Health & Social Services)

Audience and Setting

 African American adults in a community-based setting (Ypsilanti, MI) and Latino adults (Spanish and English-
speaking) in a clinic-based setting (Detroit, MI)
 Participants recruited by provider/community organization referral, advertisements in newspapers and flyers,
clinic-based computerized databases, invited presentations at churches

Approaches to Implementing Peer Support

 Peer Leader Training focuses on diabetes-related

knowledge, behavioral strategies (e.g., 5-step goal
setting model) and communication skills
 Intervention consists of a 3-month, theoretically-driven
diabetes self-management education (DSME) program
(monthly one-on-one sessions, monthly phone calls,
MD appointment preparation) followed by a Peer-Led
Empowerment-based Approach to Self-management
Efforts in Diabetes (PLEASED)

 PLEASED: 12-months of ongoing, peer-led diabetes self-management support (DSMS) weekly sessions based on
patients’ priorities, questions, and concerns to build motivation, set goals, draft action plans, problem-solve; follow-up
phone calls as needed; matched with at least one “peer buddy” for ongoing support)

Design and Methods

 Randomized controlled design

 Participants are randomized to receive either DSME co-
led by CDE/CHW and 2 peer leaders followed by 12
months of DSMS or DSME followed by 12 months of self-
directed support (control group).
 Investigating impact of PLEASED intervention following 3-months DSME at 6-months and 12-months compared to
same duration of self-directed support; also confirming impact of 3-months DSME to improve outcomes
 Outcome measures include A1C, blood pressure, lipd control, self-management behaviors (Summary of Diabetes
Self-Care Activities), quality of life (Diabetes Distress Scale), and reach to and engagement of intended audience
(RE-AIM framework)

A program of the American Academy of Family

Physicians Foundation and supported by the Eli
Lilly and Company Foundation, Inc.
 Encourage: Evaluating Community Peer Advisors and
Diabetes Outcomes in Rural Alabama
Organization: University of Alabama at Birmingham, School of Medicine
Principal Investigator: Monika M. Safford, MD
Co-Principal Investigators: Mona Fouad, MD, MPH; Andrea Cherrington, MD, MPH
Co-Investigators: Susan Appel, PhD; W. Timothy Garvey, MD, PhD; Jewell Halanych,
MD, MPH; Michelle Martin, PhD; Maria Pisu, PhD; Robert Oster, PhD, Mary Annette
Wright, PhD

Audience and Setting

 Adult patients with type 2 diabetes receiving care from Community

Health Centers in rural, impoverished Alabama’s Black Belt
 Recruiting only patients with A1c >7.5%
 “Networked Recruitment” of peer advisors: 2-3 peers initially
recruited by practice staff, then use peer social networks and other
established community networks to recruit additional peers

Approaches to Implementing Peer Support

 Pilot peer advisor training program in September 2009, piloting recruitment and the intervention November 2009
 Peer advisors collaborated in developing training curriculum; pilot peer advisors to assist in further refinement of
training and intervention
 Beginning early winter, 2-day peer advisor training to occur in each target geographic area (Central, West)
 Peers will deliver a 12-month intervention to support diabetes self-management goals, facilitate patient
empowerment, and “raise the BAR (Be prepared; Ask and learn; Reflect)” to get the most out of office visits with the
provider
 Peer advisors will make weekly, 15-20 minute contacts with clients for the first 8 weeks of intervention, and monthly
contacts thereafter; in addition, there will be contacts before and after office visits with the provider

Design and Methods

 Group-randomized, controlled implementation trial

(randomized at the practice level)
 Reach evaluated by comparing number of eligible patients
approached for recruitment with the number enrolled
 200 patients in each trial arm, total of 400
 Data collected at baseline and 12 months
 Primary outcomes: HbA1c, blood pressure, cholesterol
 Secondary outcomes: Self-management behaviors, quality of life, and psychosocial factors
 Health care utilization will be measured through medical record review
 UAB Diabetes Research Translation Center is supporting 6-month data collection and cost-effectiveness analysis

A program of the American Academy of Family

Physicians Foundation and supported by the Eli
Lilly and Company Foundation, Inc.
 Peer supports for sustainable self-care and enhancing quality
of life among diabetes mellitus type 2 patients in Thailand

Organization: Mahidol University, Faculty of Public Health, Department of Health Education

and Behavioral Science

Principal Investigator: Boosaba Sanguanprasit, PhD, MPH

Co-Investigators: Chaisri Supornsilaphachai, MD, MPH (Ministry of Public Health); Rewadee
Chongsuwat, PhD, MS; Chanuanthong Tanasugarn, MPH, DrPH; Prasit Leerapan, MEd, PhD;
Sunee Lakampan, EdD

Study Aims/Questions: Build the capacity of village health volunteers (VHV) in motivating DM type 2
patients to develop and maintain self management behaviors by applying an ecological approach

Audience and Setting

 People with type 2 diabetes (PWD) in four districts (two urban, two rural) from
two provinces – central and northeast regions – of Thailand
 20 VHVs and six health staff selected for training (Selection Criteria: must have
at least 3 PWDs in their areas of responsibility; read/write in Thai; can complete
training and project)
 VHVs (peers) function as link between communities and frontline health care
providers

Approaches to Implementing Peer Support

 Training curricula for VHVs to be developed during 5-day workshop including selected PWDs, VHVs, local health
personnel, medical doctors, and project researchers
 20 VHVs and 6 health staff attend 4-day training based on previously developed curricula and develop activity
plan at end of training
 VHV work with PWDs and families (e.g., identify problems, set goals, identify approaches for addressing them);
includes regular home visits for problem solving and providing feedback
 Frequency of home visits mutually agreed upon by VHVs and PWDs; no less than 2 visits per month
 Meetings among all PWD, families, and VHVs every two months for group support, follow-up on activities,
problem-solving, network-building, and ensuring continuity of care between community and health center

STUDY: Design and Methods

 Quasi-experimental, Two groups, pre-post test design; aim to pre and post test all 20 VHVs and 60 PWDs under
their responsibility
 Comparison group: same number of VHVs and PWDs from non-participating, similar socio-economic districts in
the same provinces
 Among participants, measuring dietary intake, physical activity, proper skin and foot care, HbA1C, blood
pressure, BMI, quality of life, perceived susceptibility, severity, self-efficacy and benefits, perceived support
received
 Among VHVs, measuring self-efficacy in providing support and motivation

A program of the American Academy of Family

Physicians Foundation and supported by the Eli
Lilly and Company Foundation, Inc.
 Diabetes Buddies
Organizations: University of California-Los Angeles,
Global Center for Children and Families (USA) with
the Stellenbosch University and Women for Peace (SOUTH AFRICA)

Investigators: Mary Jane Rotheram-Borus, Margaret Gwegwe,

Mark Tomlinson, Marion Keim

Audience & Setting

 Xhosa women with type 2 diabetes in Mfuleni Township, Cape

Town, South Africa
 Women recruited to be Diabetes Buddies (DB) at the Women for
Peace center, an NGO

Approaches to Implementing Peer Support

 22 women to be assigned to buddy-pairs (DBs) with the purpose of providing reciprocal, ongoing support
 12-week program (weekly meetings for 3 months) attended by DBs, covering nutrition, exercise, providing
reciprocal support, and managing relationships with health care providers
 Training program, based on Diabetes Prevention Program (DPP), led by a paid peer mentor
 DBs given cell phones and trained to use SMS application to record daily blood glucose levels, text message
their buddies, and receive motivational prompts

Study Methods & Findings

 One group, pretest-posttest design

 Average age of DBs was 53 years old; almost all had lived for over 5 years in their homes: formal brick
structures with running water on the premises, flush toilet, and electricity. Fewer than half had any
employment.
 All participants were assessed at baseline, 3 months, and 6 months later.
 Outcomes monitored: exercise, social support, anxiety, blood sugar, BMI, blood pressure.
 Social support showed immediate improvement at 3 months and continued to increase at 6 months.
 Exercise and diastolic blood pressure did not improve over time.
 For anxiety, BMI, blood sugar, and systolic blood pressure, outcomes appeared slightly worse at the 3-
month assessment compared to baseline, but between 3 and 6 months either leveled off or showed
improvement.
 The women who did the most text messaging with their buddies had much higher BMIs than those who
texted less, at all time points.
 Preliminary results indicate that some improvements might not occur immediately, but appear over time.

A program of the American Academy of Family

Physicians Foundation and supported by the Eli
Lilly and Company Foundation, Inc.
 RAPSID: Can Peer Support (Group or Individual Intervention)
Enable People with Diabetes and Improve Health?
Organization: Cambridge University Hospitals NHS Foundation Trust, Institute of Metabolic
Science, University of Cambridge General Practice and Primary Care Research Unit

Diabetes PLUS
Peer-Led Understanding & Support

Principal Investigators: David Simmons, FRCP FRACP MD, Jonathan Graffy, FRCGP MD

Co-Investigators: Simon Cohn, PhD; Sarah Donald, BSc; Peter Robins, MA, Vet MB; Charlotte Paddison,
PhD; Toby Provost, PhD; Mark Evans, MD, FRCP; Amanda Adler, PhD, FRCP; Catherine Walsh, FRCPsych

East of England, United Kingdom

Audience and Setting
Main study areas

 People with type 2 diabetes in East of England UK (mainly

East Cambs
Fenland

Cambridgeshire) Hunts

 Participants will be recruited through their general practitioners

(assisted by Primary Care Research Network) and community
networking
 Peers will be recruited through an initial survey, and will be
selected and trained by the study team South
Cambs

Approaches to Implementing Peer Support Content: Eductn Assist in daily Discussion of Social Linkage to
& usual management social and context clinical
care and living emotional ual Care
with diabetes aspects of life support
with diabetes

 Peers will receive training to offer assistance with living with

diabetes, motivational interviewing, and in support skills Individual
1:1
Yes Sharing
experiences
Individual
discussion
No Individual
review of care


support & mentoring access, link
via Nurse if
A diabetes nurse will assist in providing linkages to care needed

 Peer support will occur through individual and/or group settings

Group
support
Yes Sharing
experiences
& co-
Group
discussion
Yes Group
discussn of
accessing


mentoring in services. Link
Peers will have up to 10 individuals at one time for 1:1 meetings, group via Nurse if
need
give 4-10 hours per week for 6 months Combined Yes Sharing Individual Yes Both
support experiences and/or group components

 Group settings will have 20 individuals and two leads

& mentoring
(group +/-
individually)
discussion As above.

Normal Yes - - - -
Care

Overview of different support approaches

Design and Methods
1:1 Peer Support
 Cluster randomized trial with 2X2 comparison of individual,
group, combined individual/group support, and normal care
 Aim to recruit 1520 participants in 80 community clusters
 Reach assessed by recruitment rate from initial survey, Group Control 1:1 only
attendance for support sessions, intervention fidelity, and Based
comparison with routine health service data Support
 HbA1c over 12 months, body weight, blood pressure group
Group only Both
 Surveys: self-management (DSCAM), self-efficacy (DMSES),
and quality of life (EQ-5D)
 Qualitative (e.g., meaning of peer support) and economic
analyses 2 x 2 factorial study design

A program of the American Academy of Family

Physicians Foundation and supported by the Eli
Lilly and Company Foundation, Inc.