Accelerating Best Practices in Peer Support Around the World
9.10.12

Looking at a Systematic Review, Part 1: How Much Peer Support?

A recent systematic review by Dale and colleagues examined the effect of peer support on diabetes outcomes with adults.  The authors concluded that “Peer support appears to benefit some adults living with diabetes, but the evidence is too limited and inconsistent to support firm recommendations.” These conclusions were drawn from 25 studies that met inclusion criteria, including 14 RCTs. Of particular interest was the conclusion that peer support was associated with statistically significant improvements in glycaemic control in three out of 13 trials that measured HBA1C (It is noted that 1 of these 3 studies was a publication by Peers for Progress Grantee Michelle Heisler).

This blog is the first in a series that will examine these 13 studies and identify some factors that may have led to the low number of statistically significant reductions in HBA1C. This first blog will examine the dosage of “peer support” delivered in some of the RCTs while a future blog will discuss whether what was actually delivered was peer support.

The amount of peer support in one of these studies (Smith et al, 2011) was previously addressed by Peers for Progress in a 2011 rejoinder by Fisher and Boothroyd, posted on the website of the British Medical Journal. This review noted:

“Average attendance was only five of the nine meetings schedule over two years. Eighteen percent attended none. If an intervention was intended to provide peer support but was only modestly attended, one might question whether peer support has been provided sufficiently to be tested.”

With such low exposure to the intervention, it is difficult to confirm the role of peer support on HBA1C. What about the other RCT’s with no statistically significant improvement in glycaemic control analyzed by Dale and colleagues? How much peer support was delivered in them?  The following table summarizes the dose of/exposure to peer support of each of these 10.

In general, participation in these interventions was modest.  Exceptions include the paper of Glasgow et al., 2003 and Baksi et al., 2008.  In both of these, low baseline HbA1c values (7.5% and 7.4% respectively) militated against finding significant benefits of peer support on this variable.  Additionally, the paper of Baksi et al. compared group classes led by peers with those led by diabetes nurse specialists, a highly conservative control condition.

In contrast, the following table presents the attendance/delivery/dose/exposure data for the three RCTs in which Dale et al. identified peer support as having a “statistically significant beneficial impact.”

Our next blog in this series will focus on what was actually delivered in these studies and how much it agreed with the Peers for Progress definition of peer support.

References

Anderson-Loftin W, Barnett S, Bunn P, Sullivan P, Hussey J, Tavakoli A. Soul food light: culturally competent diabetes education. Diabetes Educ 2005; 31: 555–563.

Baksi AK, Al-Mrayat M, Hogan D, Whittingstall E, Wilson P, Wex J. Peer advisers compared with specialist health professionals in delivering a training programme on self-management to people with diabetes: a randomized controlled trial. Diabet Med 2008; 25: 1076–1082.

Dale J, Caramlau I, Sturt J, Friede T, Walker R. Telephone peer-delivered intervention for diabetes motivation and support: the telecare exploratory RCT. Patient Educ Couns 2009; 95:91–98.

Dale, J. R., Williams, S. M., & Bowyer, V. (2012). What is the effect of peer support on diabetes outcomes in adults? A systematic review. Diabetic Medicine : A Journal of the British Diabetic Association, doi:10.1111/j.1464-5491.2012.03749.x; 10.1111/j.1464-5491.2012.03749.x

Glasgow RE, Boles SM, McKay HG, Feil EG, Barrera M. The D-Net diabetes selfmanagement program: long-term implementation, outcomes and generalization results. Prev Med 2003; 36: 410–419.

Keyserling TC, Samuel-Hodge CD, Ammerman AS,Ainsworth BE, Henríquez-Roldán CF, Elasy TA et al. A randomized trial of an intervention to improve self-care behaviours of African American women with type 2 diabetes: impact on physical activity. Diabetes Care 2002; 25:1576–1583.

McKay HG, Glasgow RE, Feil EG, Boles SM, Barrera M. Internet-based diabetes self management and support: initial outcomes from the Diabetes Network project. Rehabil Psychol 2002; 47: 31–48.

Murrock CJ, Higgins PA, Killion C. Dance and peer support to improve diabetes outcomes in African American women. Diabetes Educ 2009; 35: 995–1003.

Smith SM, Paul G, Kelly A, Whitford DL, O’Shea E, O’Dowd T. Peer support for patients with type 2 diabetes: cluster randomised controlled trial. Br Med J 2011; 342: 715.

Pratt C, Wilson W, Leklem J, Kingsley L. Peer support and nutrition education for older adults with diabetes. J Nutr Elder. 1987 Summer;6(4):31-43.

Cade JE, Kirk SF, Nelson P, Hollins L, Deakin T, Greenwood DC, et al. Can peer educators influence healthy eating in people with diabetes? Results of a randomized controlled trial. Diabetic medicine : a journal of the British Diabetic Association. 2009 Oct;26(10):1048-54.

Lorig K, Ritter PL, Villa F, Piette JD. Spanish diabetes self-management with and without automated telephone reinforcement: two randomized trials. Diabetes Care. 2008 Mar;31(3):408-14.

Lorig K, Ritter PL, Laurent DD, Plant K, Green M, Jernigan VB, et al. Online diabetes self-management program: a randomized study. Diabetes Care. 2010 Jun;33(6):1275-81.

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