Peer Support and Diabetes Self-Management Around the World
When Peers for Progress was launched in 2006, we set out to expand the evidence base for peer support interventions in diabetes self-management. With support from the Eli Lilly and Company Foundation, we funded 14 projects in 9 countries on 6 continents.
ARGENTINA: Community-based comparison of patient education with patient education PLUS peer support
National Research Council of Argentina (CONICET) with the Centre of Experimental and Applied Endocrinology (CENEXA) and WHO Collaborative Centre for Diabetes
Juan José Gagliardino, MD
AUSTRALIA: Developing existing peer support group programs for national dissemination
Monash University and Diabetes Australia-Vic
Brian Oldenburg, PhD
CAMEROON: Community-based peer support intervention in Yaoundé
Health of Population in Transition Research Group
Jean Claude Mbanya, MD, PhD, FRCP
CAMEROON: Peer support in rural and urban districts
Centre for Population Studies and Health Promotion
Paschal Kum Awah, PhD
ENGLAND: Comparing group-based with individually provided peer support in Cambridgeshire
Cambridge University Hospitals NHS Foundation Trust, Institute of Metabolic Science
David Simmons, MD & Jonathan Graffy, MBChB, MSc, MD, FRCGP
HONG KONG: Peer support combined with automated telephone support
Asia Diabetes Foundation and Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong
Juliana C.N. Chan, MD, FRCP
SOUTH AFRICA: Peer support “buddy” program based on effective HIV model among Xhosa women
University of Western Cape and Women for Peace with UCLA Global Center for Children and Families
Mary Jane Rotheram-Borus, PhD
THAILAND: Integration of Village Health Volunteers into existing health system among four rural villages
Boosaba Sanguanprasit, PhD, MPH & Chanuantong Tanasugarn, DrPH, MPH
UGANDA: Peer champions using cell phone and face-to-face visits in rural and urban settings
Mulago Hospital with University of Wisconsin–Madison School of Nursing
Linda Baumann, PhD, APRN, BC, FAAN
ALABAMA: Community peer advisors for diabetes in rural Alabama
University of Alabama School of Medicine
Monika M. Safford, MD & Andrea Cherrington, MD, MPH
CALIFORNIA: Volunteer peer support intervention for Mexican/Mexican American adults along California-Mexico border
San Diego State University School of Graduate Public Health and Clínicas de Salud del Pueblo, Inc.
Guadalupe X. Ayala, PhD, MPH
CALIFORNIA: Impact of Peer Health Coaching on Glycemic Control in Low-Income Patients with Diabetes: A Randomized Controlled Trial
University of California at San Francisco, School of Medicine, Department of Family and Community Medicine
Thomas Bodenheimer, MD, MPH & David Thom, MD, PhD, MPH
MICHIGAN: Peer-led self-management support in “real-world” clinical and community settings among Latinos and African-Americans
University of Michigan Medical School
Michele Heisler, MD, MPA & Tricia S. Tang, PhD
TEXAS: Peer support in an HMO setting in San Antonio
American Academy of Family Physicians National Research Network (with Latino Health Access, LA Net, WellMed Medical Group)
Lyndee Knox, PhD & Wilson Pace, MD
From randomized-controlled trials to qualitative studies, the projects supported by Peers for Progress demonstrated strong evidence for peer support in terms of feasibility, reach and engagement, effectiveness, sustainability, and spread and adoption. Highlights of the findings are summarized in the table below.
|Feasibility across widely divergent systems, populations, and levels of program resources||Fourteen programs implemented in nine countries on six continents, many in severely under-resourced settings.|
|Reach, engagement and retention among high proportions of intended populations, including those “hardly reached”||Across the projects, the average retention was 78.6%. The average initial HbA1c across sites was 8.41% – as high as 11.1% at one site. Programs consistently reach and engage low-income and minority populations.|
|Effectiveness across clinical and quality-of-life outcomes||Significant reductions in blood glucose control (Hemoglobin A1c – HbA1c) across multiple projects.|
|Especially effective among those most in need||More effective among those initially low on medication adherence or self-management, and those with low health literacy.|
|Reductions in hospitalizations and other forms of costly, often unnecessary care||Among the 20% with high depression/anxiety/stress and who account for large proportions of hospitalization, reduced depression/anxiety/stress and normalized hospitalization rates.|
|Cost savings and cost-effectiveness||55% to 93% probability of being cost-effective with greater likelihood if focused on those with greater need such as those with depression or poorer initial clinical status.|
|Adoption by health systems as routine care||A health care management organization expanded its peer support program from 11 original clinics to all practices in its system – over 26 in three states.|
Building on these results, Peers for Progress is working with 8 project sites to analyze their collected clinical, behavioral, and quality-of-life data. At the start of this initiative, investigators and key staff collaborated with Peers for Progress to identify key evaluation indicators of their peer support programs that could be applied across all projects. The aim was for a core set of shared evaluation indicators that could strengthen evidence from, yet not add burden to, their individual and collective projects.
It is hoped that, beyond these eight grants, these consensus evaluation measures may serve the broader community of researchers examining peer support and self management in diabetes. Additionally, most of the measures included are not diabetes – specific and, so, may serve the broader community of research in chronic disease management and health promotion.
Peer Support and the Patient-Centered Medical Home in a Latino Population
In 2011, Peers for Progress was awarded and began planning for a comprehensive diabetes management project funded by the Bristol-Myers Squibb Foundation’s Together on Diabetes Initiative. The purpose of the project is to demonstrate and evaluate the ability of a comprehensive approach to diabetes management based in a primary care patient-centered medical home (PCMH) and emphasizing peer support and community outreach activities to improve health outcomes of the target population (approximately 4,000 low-income Latinos with diabetes).
This project is based on the assumption that the PCMH model, peer support programs and community outreach activities all play major roles in engaging low-income minorities to improve self-management behaviors and achieve improved outcomes for their diabetes. The design involves a closely evaluated demonstration project to assess the attainment of the following outcomes:
- Engagement in regular clinical care and self-management
- Improvement in self-management behaviors such as medication adherence, physical activity, healthy diet, non-smoking, etc.
- Improvement in clinical indicators such as HbA1c, blood pressure, BMI, etc., and
- Improvement in general and diabetes-specific quality of life
Additionally, we will select a research sample of 400 patients (from among the 4,000) for further study of intensive, ongoing peer support.
In this project, peer supporters will be part of the extended patient care team. They will work closely with patients and their families to encourage and facilitate access to regular clinical care, deliver diabetes education, assist patients with implementation of diabetes care plans, provide regular and ongoing follow up and support for diabetes management issues, and link patients to needed community resources.
For more information and resources about this program, click here.