PT  - JOURNAL ARTICLE
AU  - Monika M. Safford
AU  - Susan Andreae
AU  - Andrea L. Cherrington
AU  - Michelle Y. Martin
AU  - Jewell Halanych
AU  - Marquita Lewis
AU  - Ashruta Patel
AU  - Ethel Johnson
AU  - Debra Clark
AU  - Christopher Gamboa
AU  - Joshua S. Richman
TI  - Peer Coaches to Improve Diabetes Outcomes in Rural Alabama: A Cluster Randomized Trial
AID  - 10.1370/afm.1798
DP  - 2015 Aug 01
TA  - The Annals of Family Medicine
PG  - S18--S26
VI  - 13
IP  - Suppl 1
4099  - http://www.annfammed.org/content/13/Suppl_1/S18.short
4100  - http://www.annfammed.org/content/13/Suppl_1/S18.full
SO  - Ann Fam Med2015 Aug 01; 13
AB  - PURPOSE It is unclear whether peer coaching is effective in minority populations living with diabetes in hard-to-reach, under-resourced areas such as the rural South. We examined the effect of an innovative peer-coaching intervention plus brief education vs brief education alone on diabetes outcomes.METHODS This was a community-engaged, cluster-randomized, controlled trial with primary care practices and their surrounding communities serving as clusters. The trial enrolled 424 participants, with 360 completing baseline and follow-up data collection (84.9% retention). The primary outcomes were change in glycated hemoglobin (HbA1c), systolic blood pressure (BP), low density lipoprotein cholesterol (LDL-C), body mass index (BMI), and quality of life, with diabetes distress and patient activation as secondary outcomes. Peer coaches were trained for 2 days in community settings; the training emphasized motivational interviewing skills, diabetes basics, and goal setting. All participants received a 1-hour diabetes education class and a personalized diabetes report card at baseline. Intervention arm participants were also paired with peer coaches; the protocol called for telephone interactions weekly for the first 8 weeks, then monthly for a total of 10 months.RESULTS Due to real-world constraints, follow-up was protracted, and intervention effects varied over time. The analysis that included the 68% of participants followed up by 15 months showed only a significant increase in patient activation in the intervention group. The analysis that included all participants who eventually completed follow-up revealed that intervention arm participants had significant differences in changes in systolic BP (P = .047), BMI (P = .02), quality of life (P = .003), diabetes distress (P = .004), and patient activation (P = .03), but not in HbA1c (P = .14) or LDL-C (P = .97).CONCLUSION Telephone-delivered peer coaching holds promise to improve health for individuals with diabetes living in under-resourced areas.