Accelerating Best Practices in Peer Support Around the World

Workplace Wellness Meets Peer Coaching: Fuel Your Life

Clayton Velicer, MPH

Two strengths of the peer support model are 1) flexibility for adaptation to different communities or settings and 2) modularity, which offers the ability to build peer support on top of existing programs to create more effective, multi-level interventions. In the United States, the Diabetes Prevention Program (DPP) has been adapted to incorporate peer support in a variety of settings and populations.

According to the American Diabetes Association website, the DPP has 8 key features, which includes individual case managers or lifestyle coaches, frequent contact, a core curriculum that teaches behavioral self-management, and clinical support.

The role of the case manager or lifestyle coach can be adapted for peer health coaches. When Peers for Progress grantee Tricia Tang incorporated peer support into the DPP in a church-based setting, she found the adaptation feasible and enhanced the potential to improve health outcomes for high-risk African Americans.

Bring in the Peer Health Coaches

In a June article from Health Promotion Practice, Brace and Colleagues adapted the DPP to include peer coaches in a worksite setting for weight management. For this adaptation, the researchers incorporated a number of the key features of DPP into an intervention called Fuel Your Life (FYL) that utilized peer coaches in the worksite.

At the start of the program, participants met with a dietician or health educator to collect baseline measurements, to discuss expectations, and to receive all study materials. The interventions took place at six worksites, matched based on number of employees and randomly assigned to treatment or control group. All employees were eligible to participate.

The manual that was provided to participants retained the key concepts of the DPP Lifestyle Balance manual, but was modified to facilitate self-study. The manual included 16 lessons on self-management to be completed over 24 weeks. Health professionals went onsite to reinforce key messages; occupational health nurses delivered 6 presentations on FYL topics at staff meetings and sent FYL health messages to supervisors to be read at the beginning of each work shift.

Peer health coaches (PHCs) were identified by occupational health nurses at each site to be responsible for each shift. They received a training manual and met with the research staff to discuss responsibilities and expectations. Through informal contacts, PHCs were asked to provide ongoing social support to participants and emphasize key points of the curriculum.

Unfortunately, attrition proved to be an issue in this intervention and PHCs were underutilized. 479 employees were enrolled in FYL at baseline but only 236 participants completed the intervention. Of the respondents, 63% of participants indicated that a PHC was available to them, but 62% never spoke with a PHC and only 72 participants talked with the PHCs about the intervention. The authors noted that PHCs were meant to supplement the work of the occupational health nurses who were overburdened with very high case loads and a large number of employees.

Impacts on Weight Management Observed but Quality Improvement Needed

FYL participants maintained their body weight when compared to employees at control sites who experienced a 2.6-pound weight gain at 6 months. 55% of FYL participants lost weight compared with 35% in the control group. These results suggest that the intervention was successful even though the peer coaches were underutilized.

But why weren’t the PHCs used more if the participants felt they were available? The authors suggested that perhaps the participants were not comfortable discussing their weight with their peers. However, previous research with lay health workers in churches has found very high participation rates and successful weight loss for participants. What are the topics that people comfortable talking about in church-based versus workplace settings?

It would be interesting to see if the peer health coaches could deliver some of the lessons themselves as a means of decreasing the workload on occupational health nurses. Other peer-led interventions have achieved good results for peer-delivered education. Further research will be necessary to determine if this is feasible and successful in the workplace. We encourage our readers to share their thoughts on adaption of peer support programs and how they can be utilized in the workplace.

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