Peer support interventions in type 2 diabetes: Review of components and process outcomes

Abstract

Background This review seeks to identify (a) the various components and process outcomes of type 2 diabetes peer support (PS) interventions and (b) the measures implemented to monitor intervention fidelity and evaluate outcomes in these studies. Methods The MEDLINE, PubMed, EMBASE (Excerpta Medica Database), CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases were searched from inception to May 2019. Two reviewers independently screened and extracted data from eligible articles via the Template for Intervention Description and Replication (TIDieR) checklist (why, what, who provided, how, where, when and how much, tailoring, modifications, and how well). Results Twenty‐three trials were included. The total number of participants was 7178. Most interventions were in primary care. Although face‐to‐face was the most common modality of contact, rates of contact were highest for telephone. Potential peer leaders (PLs) were identified primarily through recommendations from health professionals, based on their communication skills, glycosylated hemoglobin (HbA1c), and coaching interest. PLs were mostly female, university educated, and had a long history of diabetes (≥ 10 years). PL training varied significantly in length and content; the two most frequent topics were communication skills and diabetes knowledge. Although several studies implemented methods to evaluate “intervention fidelity,” only few rigorously assessed the two key components of fidelity, “adherence” and “competence,” through audio‐ and video‐taping or direct observations. Conclusions The impact of PS on participants' health outcomes is well investigated; however, the implementation and evaluation strategies vary significantly across these studies. In the present review, we define the various components of PS interventions and propose suggestions for enhancing the implementation and evaluation of future PS models.

Effects of the Norfolk diabetes prevention lifestyle intervention (NDPS) on glycaemic control in screen-detected type 2 diabetes: a randomised controlled trial

“…The use of trained lay volunteers (with or without diabetes) to support the clinical management of people with type 2 diabetes is an attractive model in terms of workforce planning and limiting cost [ 12 – 18 , 59 – 67 ]. The level of input from trained lay volunteers can range from participating in simple support groups to acting as a leading provider of care and can be delivered in many clinical settings alongside health care professionals (HCP) [ 59 – 67 ]. In type 2 diabetes, studies describing this model have commonly been in high-income countries in minority populations in low-income settings.…”

“…In type 2 diabetes, studies describing this model have commonly been in high-income countries in minority populations in low-income settings. These lay volunteer workers have provided education, delivered a standard curriculum, or provided informational and emotional support in addition to the support from HCP [ 12 – 18 , 59 – 67 ]. The use of volunteer peer supporters with type 2 diabetes themselves in delivering a lifestyle intervention with a health care professional (HCP) to people with type 2 diabetes is a less common model that has shown inconsistent outcomes [ 17 , 59 – 67 ].…”

“…These lay volunteer workers have provided education, delivered a standard curriculum, or provided informational and emotional support in addition to the support from HCP [ 12 – 18 , 59 – 67 ]. The use of volunteer peer supporters with type 2 diabetes themselves in delivering a lifestyle intervention with a health care professional (HCP) to people with type 2 diabetes is a less common model that has shown inconsistent outcomes [ 17 , 59 – 67 ]. This study is the first to test the added effect of volunteer peer intervention alongside HCP, compared to HCP alone or a control group in newly diagnosed type 2 diabetes.…”

Results of Two Strategies for Peer-Support in Patients with Recently Diagnosed Type 2 Diabetes

“…The program's optimal development depends mainly on the knowledge and experience that peer leaders can share with the participants, so it is required that they receive training from health professionals and develop the communication skills that allow them to create a relationship of trust and empathy [19].…”

“…The choice of peers is a complicated process. It even more so is the election of leaders, who must be enthusiastic, capable of leadership, and have characteristics within the main categories of social support: appraisal support (helping a person understand a stressful event better and what resources and coping strategies may be mastered to deal with it) or informational support (giving advice and information), emotional support (warmth and nurturance expressing commitment, reassuring the person that he or she is a valuable individual who is cared for, including approval or appreciation for the patient's behavior) and tangible assistance or practical-instrumental support (material or other practical help such as services) [5,17,19].…”