Real-world insights from launching remote peer-to-peer mentoring in a safety net healthcare delivery setting

Abstract

Peer mentors have been proven to improve diabetes outcomes, especially among diverse patients. Delivering peer mentoring via remote strategies (phone, text, mobile applications) is critical, especially in light of the recent pandemic. We conducted a real-world evaluation of a remote diabetes intervention in a safety-net delivery system in New York. We summarized the uptake, content, and pre-post clinical effectiveness for English- and Spanish-speaking participants. Of patients who could be reached, 71% (n = 690/974) were enrolled, and 90% of those (n = 618/690) participated in coaching. Patients and mentors had a mean of 32 check-ins, and each patient set an average of 10 goals. 29% of the participants accessed the program via the smartphone application. Among participants with complete hemoglobin A1c data (n = 179), there was an absolute 1.71% reduction (P < .01). There are multiple lessons for successful implementation of remote peer coaching into settings serving diverse patients, including meaningful patient-mentor matching and addressing social determinants.

Racial Health Equity and Social Needs Interventions

“…Among 152 studies in multiracial or multiethnic populations, only 21 (14%) 26 , 28 , 29 , 47 , 62 , 68 , 78 , 80 , 87 , 93 , 95 , 96 , 101 , 126 , 128 , 151 , 159 , 161 , 165 , 170 , 171 reported whether intervention outcomes differed by race or ethnicity of participants. Another 23 studies 23 , 30 , 34 , 35 , 58 , 63 , 66 , 74 , 82 , 83 , 85 , 92 , 94 , 102 , 117 , 129 , 135 , 142 , 143 , 163 , 167 , 168 , 169 (15%) included race or ethnicity in their analyses as confounders.…”

“…Two-thirds of the studies (14 of 21 studies [67%]) 28 , 62 , 68 , 78 , 87 , 93 , 95 , 96 , 101 , 126 , 151 , 161 , 170 , 171 categorized as analytically informative reported no differences in intervention outcomes by race or ethnicity. Among the 7 studies that did find differential intervention outcomes by race or ethnicity, 26 , 29 , 47 , 80 , 128 , 159 , 165 6 were studies of relatively intense case management or community health worker/peer mentor outreach in diverse settings, and 1 addressed the Reach Out and Read–based intervention for children ( Table 2 ).…”

“…Among the 7 studies that reported differential intervention outcomes, 4 found that the interventions benefited minoritized racial or ethnic populations more than White populations or reduced inequities in minoritized compared with White populations. 26 , 128 , 159 , 165 Among the 3 remaining studies, 1 reported better outcomes in Latino children receiving the intervention when compared with those not receiving the intervention. 29 In that study, however, there was not a statistically significant difference between intervention and comparison clinics, which also included Black participants.…”

“… 23 , 30 , 34 , 35 , 58 , 63 , 66 , 74 , 82 , 83 , 85 , 92 , 94 , 102 , 117 , 129 , 135 , 143 , 163 , 167 , 168 , 169 More than one-third (18 [41%]) were characterized as analytically informative but not conceptually thoughtful. 26 , 29 , 47 , 62 , 68 , 78 , 80 , 87 , 93 , 95 , 96 , 101 , 126 , 128 , 151 , 159 , 170 , 171 Among the 21 analytically informative studies, only 3 were also categorized as conceptually thoughtful. 28 , 161 , 165 One study (2%) 142 was conceptually thoughtful but not analytically informative: thoughtful because the authors attributed racial and ethnic differences in 1 of the outcomes—psychological distress—to structural racism, but noninformative because analyses of intervention outcomes were adjusted for race or ethnicity rather than stratifying or testing for outcome modification by race or ethnicity.…”

“… d Juillard et al, 26 Mendelsohn et al, 29 Tessaro et al, 47 Slesnick et al, 62 Kelley et al, 68 Ziang et al, 78 Glendenning-Napoli et al, 80 Krieger et al, 87 Chaiyachati et al, 93 Krieger et al, 95 Krieger et al, 96 Lapham et al, 101 Chan et al, 126 Hilgeman et al, 128 Foster et al, 151 Lyles et al, 159 Duncan et al, 170 Whorms et al 171 …”