Peer Coaching to Improve Diabetes Self-Management Among Low-Income Black Veteran Men: A Mixed Methods Assessment of Enrollment and Engagement

In this study, Turner et al. describe those characteristics of Black men with diabetes that are associated with 1-likelihood of enrolling in a peer-coaching program provided by Veteran’s Affair affiliated health centers and 2-once enrolled, likelihood of engagement with a peer-coach led program designed to improve diabetes self-management. The authors undertook this study to improve the targeting of their peer-coaching intervention and to better understand how to design mentorship training for future success in engagement of individuals struggling with complex comorbidities. Black men with chronic disease carry the highest risk of adverse health outcomes as compared to other socio-demographic groups. The authors compared characteristics of individuals who enrolled in the peer-coaching intervention as compared to those who did not. Though overall enrollment was low (44%) and of those enrolled about 50% remained engaged with the study, validated surveys showed that Black men with higher educational attainment, higher scores on ease of establishing social relationships, and surprisingly worse diabetes control and self-management, were more likely to enroll. They attributed their success in enrolling these individuals, elsewhere identified as some of the most difficult to engage, to the fact that the intervention was offered by the VA and that peer coaches were matched by race, age and gender. Thus, support offered by fellow veteran Black men was meaningful to those who participated in the study. Qualitative interviews of participants also support this notion and show that the sense of kinship felt with fellow veterans and other Black men with diabetes, helped to overcome their sense of alienation from other health providers.
While baseline characteristics were similar between those enrolled participants who did and did not engage in peer-coaching over the course of the study, support of autonomy by the peer coach was the only significant quality identified as being important to those who remain engaged. These findings are valuable in the design of future programs to better engage Black men. Strong gender-based value and beliefs about their societal role, not to mention a history of systematic abuse and exclusion by their society, have naturally led to reluctance by Black men to engage with health services. Offering non-judgmental peer-coaching (with special emphasis on fidelity of the peer coaching to this style of mentorship) may be an effective strategy to overcome barriers to self-care experienced by Black men.

Ladan Golestaneh MD, MS