Appendix 1
Comellas M, Walker EA, Movsas S, Merkin S, Zonszein J, Strelnick H (2010) Training Community Health Promoters to Implement Diabetes Self-Management Support Programs for Urban Minority Adults. Diabetes Education. Volume 36(1). pp. 141–151.
(Below is a table consisting of 6 columns and 2 rows including 1 header row)
Study Purpose& Type / Sample Characteristics / Intervention/Method / Outcome / Measures / Results / Limitations
Develop, implement and evaluate peer led self management support programme in Eng/Spanish.
Pilot study / Recruited from: New York community newspapers and flyers posted in libraries, bodegas, community/health
centers, churches
12 Female, 5 Male, mean age 66.8, 11 retired, 2 unemployed 1 pt-time 1 full time work,
1 insulin injection, 11 oral diabetes medication.
Exclusions: prescreened by phone
Inclusions: +18y diagnosis of diabetes, Hispanic or black male/female
n = 17 / Los Cominos self management Program: Goals to improve communication with health providers, problem solving, goal setting.
Develop training for peers (community health promoters (CHPs) to facilitate ‘diabetes discussion circles’ / Outcomes:
Improved diabetes self management behaviours i.e. increased physical activity, healthier eating, medication adherence, problem solving and goal setting
Measures:
· 5-item WHO well being scale
· Diabetes Self-Care Activities (SDSCA)
· Medication adherence over past 7 days
· Self report re step meter. / Pilot Study est. the acceptance and feasibility of both peer training and a community based, peer led programme for disadvantaged minority adults with diabetes.
Exercise (P = .04)
Significant improvements found in physical activity and nutritional activities: modest improvement in well being / Originally planned to study Hispanics only but difficulty in recruiting due to poor understanding of self management programme and perceived discrimination, poor communication and distrust in health care system
within Bronx NY population; African Americans included
Recommendations
Need to Improve multicultural communication and interactions
Jerant A, Moore-Hill M, Franks P (2009) Home-Based, Peer-Led Chronic Illness Self-Management Training: Findings From a 1-Year Randomized Controlled Trial. Annals of Family Medicine. Volume 7. No. 4.
(Below is a table consisting of 6 columns and 2 rows including 1 header row)
Study Purpose & Type / Sample Characteristics / Intervention/Method / Outcome / Measures / Results / LimitationsCDSMP with 1 year follow up and pre-designated primary outcomes
RCT / Recruited from:
Primary care services in Northern California US via telephone & announcements
Exclusions: none documented
Inclusions: +40y diagnosis of 1 or more conditions arthritis, asthma, COPD, Heart failure, depression, diabetes
n = 415 / Compared usual care with either a telecare or (HIOH) one to one home delivered variant of the CDSMP in improving self efficacy and health status.
Randomised outpt. to HIOH delivered:
homes (n =138)
phone (n = 139)
usual care (n = 138)
completed
home (n = 116)
phone (n = 119)
usual care (n = 128)
Participants received $25 gift card after 5 scheduled follow up calls / Outcomes:
Improved
Self efficacy
Health status
Depression
Function
Medication adh.
Health care use
Measures:
· self efficacy -10 point Likert scale
· health status MCS 36 PCS 36
· 5 item general health GH subscale EuroQoL (EQ)
· Function HAQ
· depressive symptoms
· 10 item CES –D
· Medication adherence 7 days preceding data collection
· health care use and medication from baseline / No sig. effects
of HIOH delivered by telephone at any time
Self efficacy 6weeks
P = .001
6mth
P = .01
Not present at 1year
Health status
and other outcomes: No sig. differences in primary outcomes
Follow up
6 week
6 month
12 month / Participants predominately white, female, married and well educated therefore unable to generalise findings.
Higher drop out rate in the intervention groups.
Favourable baseline status.
Recommendations
Findings challenge the suggestion that wider application of peer led illness self management programmes would be cost effective.
Read Kate Lorig’s response to above recommendation: http://www.annfammed.org/content/7/4/319/reply
Cade JE, Kirk SFL, Nelson P, Hollins L, Deakin T, Greenwood DC, Harvey EL (2009). Diabetes UK. Diabetic Medicine. Vol.26, pp.1048–1054.
(Below is a table consisting of 6 columns and 2 rows including 1 header row)
Study Purpose& Type / Sample Characteristics / Intervention/Method / Outcome / Measures / Results / Limitations
To assess if the EPP adapted for people with Type 2 diabetes can be used to promote healthy eating to improve glycaemic control.
RCT / Recruited from GP practices in Burnley, Pendle and Rossendale area of Lancashire
Mean age 65.4
43% female
57% male
95% white
Inclusions:
Pts with Type 2 diabetes
Reg with GP practice selected from socially deprived catchment area using Jarman Scores
Exclusions: none documented
n = 317 / 1st phase pts approached to become peer educators
5 recruited, 4 trained with 1 NHS EPP tutor paid to provide support for 6mths
2nd phase
Pts for intervention recruited from above GP practices.
Pts received either diabetes specific EPP (n=162) or
Individual one off appointments with a dietician (n=155)
Pts attended a group session for 2-h once a week for 6 weeks + a final 2-h session / Outcomes:
Primary clinical outcome was a change in glycated haemoglobin
Others included
Weight
BMI
Waist circumference
Lipid profile
Blood pressure
Measures:
Repeated 3 day food diaries and questionnaires
(DES)
AADDQoL
Qualitative interviews
Follow up 6 & 12mths / No statistically significant differences between control group in any clinical or dietary outcomes. / Major weakness was drop out between randomization and baseline due to unexpected delays in setting up programme.
Low response rate to follow up.
Considerable disappointment expressed regarding course content i.e less self management skills and more personal approach directed at specific diabetes info. Many described self management as ‘common sense’ something they already possess!
Recommendations
Disease specific prog.
Containing medical info and self management techniques.
Lorig K, Ritter PL, Villa F, Piette JJK (2008) Spanish Diabetes Self-Management With and Without Automated Telephone Reinforcement Diabetes Care. Volume 31 Number 3.
(Below is a table consisting of 6 columns and 2 rows including 1 header row)
Study Purpose & Type / Sample Characteristics / Intervention / Outcome / Measures / Results / LimitationsTo determine if pts in the SDSMP demonstrate improvements in health status, health behaviours and self efficacy. Also if SDSMP pts receiving monthly automated phone reinforcement maintain improvement at 18 months better than those not receiving reinforcement.
RCT / Recruited from: 6 San Francisco Bay Area counties. Programme was advertised in the community by word of mouth, by announcements in churches clinics and by Spanish language media. Potential pts contacted the study via a toll-free Spanish telephone line.
46 SDSMP workshops between 2002 - 2005
Age (21-84)
Female 57%
Inclusions: Pts>18yrs
Not pregnant or in care for cancer
n = 567 / SDSMP is a 6 week programme 2.5hpw,
led by 2 Spanish speaking peers, who had received 4 days training, class sizes ranged from 10-15. this was augmented by a monthly automated call at the end of which pts were given the option to leave a message which would be responded to by a staff member if necessary. / Outcomes: Health status, health behaviours, health care use
Self efficacy
· A1C – BIOSAFE kits
· Piette scale
· Activity limitation scale
· Medical Outcome Scale
· National Health survey
· 4 item scale measured communication
· health care use self report
Follow up 6mths and 18mth / 6 month follow up:
self efficacy (P = 0.001)
Health status
A1C (P=0.040)
health behaviours
(P=0.891)
18 month: all improvements persisted (P = 0.05)
trend toward fewer visits to physicians
Little additional benefits from automated phone calls, at 18 months only difference increased glucose monitoring. / Not blinded
Non completers high
18 month follow up had no control group
Recommendations
Future studies might explore the effectiveness of face to face reinforcement.
Baksi AK, Al-Mrayat M, Hogan D, Whittingstall E, Wilson P, Wex J (2008) Peer advisers compared with specialist health professionals in delivering a training programme on self-management to people with diabetes: a randomized controlled trial Diabetes UK. Diabetic Medicine 25. pp. 1076–1082.
(Below is a table consisting of 6 columns and 2 rows including 1 header row)
Study Purpose& Type / Sample Characteristics / Intervention / Outcome /
Measures / Results / Limitations
To assess the effectiveness and acceptability of peer advisers (PADs) delivering a self management progamme for people with diabetes compared to the same programme delivered by specialist health professionals (SHPs)
RCT / Recruited from Isle of Wight NHS Primary Care Trust
Age
(PADs) 60
(SHPs) 59
Exclusions:
Pts who were unable to participate in a group setting (impaired vision or hearing), those who had already received extensive coaching i.e. pts using insulin pump and PADs
n = 83 / Person centred educational programme delivered by either SHPs or PADs suitable for people with type 1 and 2 diabetes.
Following training PADs were formally assessed by a written test followed by 40m oral exam.
Each course consisted of 6 sessions held weekly, sessions were interacted pts were encouraged to raise issues from personal experience / Outcomes
Change in knowledge in 5 domains
Glycated haemoglobin HbA
Diabetes Care Profile
Measure
American Ass. of Clinical Endocrinologists (AACE) / PADs - knowledge scores improved in all 5 domains
SHPs knowledge improved in 3 domains.
No significant difference was found between PADs and SHPs in change of HbA and diabetes care profile. / Recommendations
The use of peer advisers could complement services provided by specialist health providers, would be particularly relevant where resources are limited.
Kennedy A, Reeves D, Bower P, Lee V, Middleton E, Richardson G, Gardner C, Gately C, Rogers A (2006) The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial. Epidemiol Community Health. Vol. 61. pp. 254–261.
(Below is a table consisting of 6 columns and 2 rows including 1 header row)
Study Purpose& Type / Sample Characteristics / Intervention / Outcome Measures / Results / Limitations
To assess the effectiveness and cost effectiveness of a national lay led self care support programme for patients with long term conditions.
RCT / Recruited from all 28 Strategic Health
Authorities in England.
No specific in/exclusions beyond a self defined long term condition.
Female 70%
White 95%
Mean Age 55
n = 629
n = 313 intervention
n = 316 control / Anglicised version of CDSMP involving 2.5h group sessions held weekly.
8-12 pts taught by pair lay trainers who had trained and were subject to quality assurance
6 month follow up / Outcomes
· Self efficacy
· Energy
· Health care use
· Better communication with health care staff
· Cost effectiveness
Measures
EuroQoL / Primary outcomes
Self-efficacy P= 0.000
Energy P =0.18
Health care visits` P =0.03
Energy P =0.004
Health care visits P = 0.732
Secondary outcomes
General health 0.083
Social role limitations) 0.002
Pain 0.129
Psychological well-being 0.000
Health distress 0.003
Exercise 0.047
Partnership with clinicians 0.003
Diet 0.126
Complementary products 0.562
Relaxation 0.018
Information seeking 0.096 / 6 month follow up
Unclear which components or aspects of the interventions are most effective.
Recommendations
The programme may be a useful addition to current provision for long term conditions.
Barlow JH, Wright CC, Turner AP, Bancroft GV (2005) A 12-month follow-up study of self-management training for people with chronic disease: Are changes maintained over time? British Journal of Health Psychology. Vol. 10. pp. 589-599.
(Below is a table consisting of 6 columns and 2 rows including 1 header row)
Study Purpose& Type / Sample Characteristics / Intervention / Outcome Measures / Results / Limitations
To assess whether changes in outcomes were maintained over 12 months in pts who had participated in a previous CDSMC with 4 month follow up / Female 73%
White 97%
Mean Age 54
Duration of condition 16+ years
n = 171 / CDSMP involving 2.5h group sessions held weekly.
8-12 pts taught by pair lay trainers who had trained and were subject to quality assurance
Data collected by self administered questionnaires mailed to pts 12 months after they commenced a CDSMC and via telephone intrviews.
12 mth follow up / Outcomes
· Self efficacy
· Physical functioning
· Behavioural and cognitive techniques
· Pain and fatigue
· Psy. well being
Health care utilisation
Measures
HAQ
Self efficacy and behave. and cognitive sub scales (Lorig 1996)
Exercise min per week
10cm horizonal Visual Analogue scales (VAS)
HADS
Visits to GP, A&E no. of nights spent in hospital / Significant improvements in
outcomes identified at 4 months (i.e. cognitive symptom management, self-efficacy,
communication with physician, fatigue, anxious and depressed moods and health
distress) were sustained at 12 months. No significant changes between 4- and 12-month ax were found on any study variables. Interview data confirmed that
participants continued to use some of the self-management techniques learned on the course / Not randomised.
Recommendations
Longer follow up studies needed to determine if benefits are maintained.
More objective measures.
Future research might focus on why people do not enrol in self management programmes.
Griffiths C, Motlib J, Azad A, Ramsay J, Eldridge S, Feder G, Khanam R, Munni R, Garrett M, Turner A, Barlow J (2005) Randomised controlled trial of a lay-led self-management programme for Bangladeshi patients with chronic disease. British Journal of General Practice.
(Below is a table consisting of 6 columns and 2 rows including 1 header row)
Study Purpose& Type / Sample Characteristics / Intervention / Outcome Measures / Results / Limitations
To determine the effectiveness of a culturally-adapted
lay–led self-management programme for Bangladeshi
adults with chronic disease.
RCT / Recruited from Tower Hamlets east London
Mean age 48 in both control and intervention
Female 56% intervention
58% control
Bangladeshi
n = 238 in both control and intervention
n = 476 / Programme was a culturally adapted
version of the CDSMP. Pts were sent invitations by
post with details of the venue and
times of sessions. To encourage attendance transport offered to and from the venue by taxi and those
who attended five or more sessions a
certificate of attendance and a supermarket voucher. / Outcomes
· Self efficacy
· Physical functioning
· Behavioural and cognitive techniques
· Pain and fatigue
· Psy. well being
Health care utilisation
Measures
Chronic Disease Self-Efficacy Scale / Self-efficacy P <0.001
Self care behaviour P = 0.047
Communication with physician P= 0.112
Health status
Depression Anxiety P= 0.724
Pain P = 0.360
Fatigue P =0.922
Shortness breath P =0.249
Healthcare use P= 0.751
Visits to GP/practice nurse P= 0.625 / Lack of physiological
measures of disease control, short follow up, and
lack of quantitative assessment of validity of the
cross culturally adapted outcome scales.
Recommendations Further work should determine ways
of improving uptake, and longer-term impact of the
programme on health status, metabolic and
physiological outcomes, and healthcare use.
Fu D, Fu H, McGowan P, Shen Y, Zhu L, Yang H (2003) Implementation and quantitative evaluation of chronic disease self management programme in Shanghai,China: randomized controlled trial. Bulletin of the World Health Organisation. Volume 81(3). pp.174–82.