Analysis of a Successful Diabetes Peer Support Program in Argentina
Clayton Velicer MPH
The evidence for the benefits of peer support on diabetes self-management continues to build as successful peer support programs are implemented around the globe. For examples of peer support and diabetes management please check out our science behind peer support section, or read our previous blog series highlighting a peer support program in Cambodia.
Gagliardino and colleaguescontribute to this growing body of evidence by demonstrating the effectiveness of peer support for diabetes self-management in Argentina. Their study was supported by a grant from Peers for Progress.
In their article, Gagliardino and colleagues compared health outcomes for people with type 2 diabetesone year after attending either 1) a diabetes education program deliveredby professional educators or 2) the same program delivered by trained peers that also providedin-person support at group meetings and ongoing support through phone contacts. Both groups showed comparable positive effects on clinical, metabolic and psychological indicators immediately after completing the program. However, the participants that received peer support had lower A1C, systolic blood pressure, and better control of hypoglycemic episodes in the year after the program was completed. This blog will examine some of the key aspects of the program to explore the factors that contributed to its success, including the training of peer supporters, the dose of peer support delivered, and the kind of ongoing support that was provided.
Recruitment and Training
In this study, peers were recruited from The Houssay Centre, a local organization devoted to the education of people with diabetes. Peers were selected based on evidence of excellent diabetes control, self-motivation, communication and support skills, as well as a strong interest in the program. Peers received a 3-day intensive, structured small-group interactive courses that focused on “pedagogic, motivational, communication and group management techniquesas well as basic diabetes control/treatment and evaluation concepts.” The training program was based on the curriculum of the health professionals TrainingCourse on Diabetes Education.
As highlighted in our recent program protocol blog, providing ongoing support for peer supporters can be very important to program success. Ongoing support in this program was provided by a monthly meeting with the study coordinator (Dr. Gagliardino) and the education team to share challenges and successes, and prepare quarterly reports for the patients’ physicians.
As noted in our analysis of a recent systematic review on peer support programs, the dose delivered in peer support programs is correlated with improvements in health outcomes. In this study, participants in both the professional-led and professional-led plus peer groups received four weekly group education sessions that lasted 90-120 minutes. The groups had no more than 10 patients. The education sessions covered a wide variety of topics including general concepts about type 2 diabetes, symptoms of hypoglycemia and hyperglycemia, glucose self-monitoring, importance of active patient participation in disease control and treatment, the impact of weight on insulin sensitivity, food selection, importance of foot care, regular physical activity and examinations and laboratory tests necessary for good diabetes care.
While both groups received education on these topics, the group with peer support continued to receive psychological and behavioral support. Using their personal experience, peers provided support by guiding patients on practical ways to apply skills learned in the education sessions. Peers were matched to participants according to sociodemographic characteristics to remove barriers to communication, trust, and rapport-building.
Following the initial education course, peers had regular scheduled contacts with their supportees. This contact included face-to-face visits every second month and telephone calls at least weekly for the first 6 months. Telephone support continued weekly for 3 months after the initial period and monthly for the remaining study period. It is important to note that maintaining regular contact may have been critical to the program’s success as ongoing support is one of the 4 key functions of effective peer support.
Additionally calls made by peers were based on structured interviews and inquired into the patient’s health progress including questions on body weight, blood pressure, blood glucose monitoring, psychological status, medication, meal plan and physical activity adherence. This information was shared with the program coordinator and became part of the patient’s follow-up. Lastly, monthly group calls between peers were promoted as a way to share experiences and troubleshoot problems.
Results and Implications
Both professional and peer-led groups had significant increases in diabetes knowledge and decreases in diabetes symptoms. Participants in both groups expressed similar positive opinions about the quality and usefulness of the education course. This suggests that peer-led education was not inferior to the professional-led education. Additional research is needed to quantify the cost savings from using peer supporters for these kinds of education programs, which can be especially helpful in areas with limited availability of professionals and health resources.
From a clinical standpoint, the authors note that both groups showed significant improvements in several symptoms of diabetes management, but the group receiving peer support showed significant improvements in systolic blood pressure while the control group showed none. Furthermore, in the peer group,the number of hypoglycemic episodes decreased significantly and positive attitudes increased for the prevention and control of hypoglycemia. The authors conclude that these indicators of diabetes management are evidence of the benefit of providing ongoing support.
Taken as a whole, the program described in the article by Gagliardino and colleagues provides details on a peer support program that features many elements of successful peer support. As outlined in our What is peer support? section, this program satisfies the 4 key functions of peer support by:
1) Providing assistance in daily management (outlined as a topic in the training curriculum for peers)
2) Emotional and social support (provided in-person and via phone follow up)
3) Linkage to clinical care (the sessions were led by a professional diabetes educator and measurements were shared with health professionals)
4) Ongoing support (the participants received weekly calls from peers after all education sessions had been completed)
The program also featured several models for providing peer support by having peer supporters participate in face-to-face group sessions and one-to-one phone contact. Both of these models are described in Heisler’s description of 7 successful models of peer support. We thank Gagliardino and colleagues for documenting the success of this peer support program and encourage our readers to contribute some of their thoughts on the factors that contribute to successful programs.