Article Figures & Data
Figures
- Figure 1.
Study flow diagram.
Tables
Characteristic Not Enrolleda (n = 149) Enrolled (n = 290) P Value Age, mean (SD), y 66.9 (10.9) 63.7 (10.1) 0.13 Sex: male, No. (%) 143 (96.0) 283 (97.6) 0.35 Race: Black, No. (%) 57 (41.6) 170 (60.9) <.001 Education >high school graduate, No. (%) 84 (56.8) 200 (69.0) 0.01 HbA1c, mean (SD), % 9.18 (1.37) 9.51 (1.54) 0.03 Employed, No. (%) 31 (21.4) 74 (25.8) 0.31 Annual income <$30,000, No. (%) 57 (59.4) 142 (57.5) 0.75 Finds it easy to get close to others, No. (%) 97 (67.4) 237 (81.7) <.001 Diabetes self-management: fair/poor, No. (%) 46 (31.5) 145 (50.0) <.001 Self-reported health status: fair/poor, No. (%) 64 (43.8) 129 (44.5) 0.9 Satisfied with VA health care, No. (%) 140 (93.9) 270 (93.1) 0.58 HbA1c = hemoglobin A1c; VA = Veterans Affairs.
↵a Declined enrollment but completed the brief survey.
Characteristic Not Engaged (n = 123) Engaged (n = 167) P Value Age, mean (SD), y 64.0 (10.1) 62.6 (10.2) .27 Sex: male, No. (%) 122 (99.2) 161 (96.4) .13 Race: Black, No. (%) 73 (59.3) 108 (65.1) .61 Education >high school graduate, No. (%) 36 (29.3) 54 (32.3) .58 HbA1c, mean (SD), % 9.1 (1.7) 9.1 (1.7) .94 Employed, No. (%) 30 (24.6) 44 (26.7) .69 Annual income, <$30,000, No. (%) 60 (59.4) 82 (56.2) .61 Finds it easy to get close to others, No. (%) 85 (69.1) 126 (75.4) .23 Diabetes self-management: fair/poor, No. (%) 54 (43.9) 91 (54.5) .08 Self-reported health status: fair/poor, No. (%) 57 (46.3) 72 (43.1) .58 Satisfied with VA health care, No. (%) 113 (91.9) 157 (94.0) .20 Type 2 diabetes distress score, mean (SD)a 71.5 (26.0) 74.5 (22.1) .31 Medication adherence score, mean (SD)a 90.9 (20.7) 89.6 (20.7) .60 Exercise score, mean (SD)a 43.8 (32.4) 40.6 (31.6) .41 Coach autonomy supportiveness scale score, (SD)a 70.7 (24.7) 85.4 (16.0) <.001 HbA1c = hemoglobin A1c; VA = Veterans Affairs.
↵a Possible values range from 1 to 100, with higher values indicating higher level of distress, greater medication adherence, higher frequency of exercise, and higher level of perceived autonomy supportiveness, respectively.
Time HbA1c Level, Mean, % HbA1c Change,a Mean, % Between-Group Difference in HbA1c Change,a Coefficient Not Engaged Engaged Not Engaged Engaged Baseline 9.07 9.08 … … … 6 months 8.58 8.27 −0.50 (P = .01) −0.81 (P <.001) 0.32 (P = .19) 12 months 8.52 8.55 −0.61 (P = .01) −0.51 (P = .001) 0.10 (P = .71) HbA1c = hemoglobin A1c
↵a Within-person change.
- Table 4.
Main Themes and Illustrative Quotes From Interviews With 14 Participants Who Engaged in the Peer Coaching Intervention
Common ground and shared experiences with coach (mentioned by 11 participants)
“We had a little bit more in common…He (coach) was a heavy set guy and lost weight, and he was telling me about his experiences with diabetes and what he was going through. And it was similar to mine—what I was going through. And it was a good vibe.”
“We had a lot of things in common. For one, I like my crafts. I’m steady at it. We naturally discussed sports.”
“Veteran conversations are very different, and after you’re out of the service, you don’t get to talk and hang around a lot of veterans. It was nice to talk to someone who has been to Taiwan, Hawaii, Germany, etc… Veteran talk.”
“We talked about some things men don’t usually talk about with each other—erectile dysfunction as a complication of diabetes. Guy talk is sometimes sterile, but [we] just broke it down… 2 guys with similar experiences, bouncing things off each other and being genuine with the answers, which were not the type that you would get from a stranger.”
“He [coach] was telling me some of the things he had to go through and some of the things changed his life. I was like ‘Wow, I went through the same stuff.’ I would tell him about my feet pain…we would just [be] exchanging conversations and so forth. And I think that’s when we really connected.”Encouraging, supportive, authentic stance from coach (mentioned by 10 participants)
“Yeah, I expected it to be more like a football coach, encourage you, egging you on all the time. Actually, it was a perfect relationship. He didn’t push too hard, which I would have with drew more. He came on at the right setting; he wasn’t too pushy or not pushy enough.”
“With him, I could keep it real. I could tell him I didn’t do this or that. He didn’t judge me. He would encourage me.”
“I remember him asking ‘How are you doing with your goals?’ Then he would identify one or two that we made. Then he would ask me what actions could I take to get there. He didn’t say, ‘Aw you dummy!’ He was positive and really showed that he wanted to help me take those steps to get to my goals.”
“The encouragement. There were times he was willing to listen as much as he talked, and that was very helpful. You have to be willing to hear what other people say instead of just throwing your opinions at them.”Accountability and consistency from coach (mentioned by 9 participants)
“Having someone that was holding me accountable made me more serious about what I needed to do.”
“…just having someone to check/monitor you on how you’re doing. It kind of keeps you on your toes because you know you’re going to hear from them.”
“Because I would come close to the weekend when I would expect his call, I would think about it [diabetes] a little more and work on my goals a little bit better.”
“He held me accountable to what I said I would do. Versus when I go to the doctor, they just generally ask what you are doing. With him, I was held accountable. I knew I would talk to him every week so I had to do what I said I would do.”Helpful tips and self-management information from coach (mentioned by 8 participants)
“He called me and we conversed…he gave me hints on how to eat proper, watching what I ate.”
“Me and the coach talked quite a bit about exercise, being active, how that helps you feel better, how that helps the insulin absorb better. We had quite a few conversations about being more active was a definite benefit.”
“I felt like he was really going to be able to help me. He told me about things that I didn’t know about diabetes. [He] told me about some nutritional things, like my protein intake was important. He also gave me a lot of exercise tips.”
“He (coach) was telling me the importance of about what you can gauge how you’re doing, how well the medication is doing.”Intentional focus on improving self-management behaviors (mentioned by 8 participants)
“Changing my eating habits and exercising. Even watching the things I drink, just drinking more water. Basically just changing my lifestyle and remember who I was doing this for, which was myself. Just changing my thinking. Being more positive. It wasn’t just about the diabetes. It was more about my overall health.”
“Before, I wasn’t taking my medicine like I should and that was a big problem. Now, every morning, boom, before I walk out the door I make sure I got my medicine” “[I] became more conscious of what I ate, started looking at labels more, cut out some foods, and watching my sugar intakes.”
“I was a good vet for [this] because I was all in. I can’t wait for [coach] to call me, because it’s working.”
Supplemental appendix
- Turner.pdf -
Supplemental appendix
- Turner.pdf -
Visual abstract
In Brief
Peer Coaching to Improve Diabetes Self-Management Among Low-Income Black Veteran Men: A Mixed Methods Assessment of Enrollment and Engagement
Cassie D. Turner and colleagues
Background Turner et al's study assessed the characteristics of low-income, Black veteran men who participated in a peer coaching program called Technologically Enhanced Coaching: A Program to Improve Diabetes Outcomes (VA-TEC) at the John D. Dingell VA Medical Center in Detroit and analyzed their levels of program engagement and health outcomes at six and 12 months.
What This Study Found The authors found that autonomy-supportive peer coaching is associated with higher levels of patient engagement. At six-month follow-up, participants who evaluated their peer coaches as highly autonomy-supportive were more likely to have engaged in the program than participants who rated their coaches lower on autonomy supportiveness. Additionally, the authors highlight characteristics of peer coaches who contributed to increased patient engagement including: shared background and lived experiences with participants; sharing information on resources and self-management strategies that were helpful in their own lives; being encouraging, supportive, and authentic during sessions; and being reliable and consistent.
Implications
- These findings provide important insights for self-management support programs tailored to promote positive health outcomes for low-income Black veteran men.
