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The Article in Brief
Peer-Delivered Cognitive Behavioral Training to Improve Functioning in Patients With Diabetes: A Cluster-Randomized Trial
Monika M. Safford , and colleagues
Background Rural communities in the Southeastern United States have the highest prevalence of diabetes in the nation. They face considerable barriers to successful diabetes self-management, and up to 75% of adults with diabetes report chronic pain, and may also have depression, anxiety, and physical or emotional disabilities. Cognitive behavioral therapy (CBT) is an effective nonpharmacologic intervention for chronic pain, but it hasn't been well studied in diabetes and chronic pain. Evidence for the effectiveness of peer coach-delivered CBT-based programs for diabetes and chronic pain is also limited.
What This Study Found Trained community members in rural Alabama delivered a diabetes self-management program that incorporated cognitive behavioral approaches to overcoming pain as a barrier to physical activity. Peer trainers were African American women who had personal experiences with diabetes and were lifelong community members. Similarly, participants were mostly low-income African American women recruited through community connections and assigned to the intervention by town block randomization. Adults who completed the 10-week program showed significant improvements in functional status, pain, and quality of life, when compared to a peer-led general health advice control group. At the end of the program, adults in the cognitive behavioral therapy�based program were more likely to report having no pain or finding alternative exercises when pain prevented them from walking.
Implications
- These results demonstrate that peers trained to deliver CBT-based interventions can improve health outcomes in areas where access is limited.
- A peer-delivered program for managing diabetes and chronic pain was shown to be beneficial for rural adults in communities that might otherwise lack access to physician-led services.