The Michigan men’s diabetes project: perspectives on a peer-led diabetes self-management and support intervention for Black men with type 2 diabetes

Abstract

Background Black men are more likely to be diagnosed with type 2 diabetes (T2D) compared to non-Hispanic White men, especially those over 55 years of age. Although there is ample evidence around the efficacy of peer-led diabetes self-management and support (PLDSMS) programs in improving diabetes health outcomes, Black men living with T2D experience several barriers to meaningful participation in peer-led programs and program developers face barriers to implementation. This qualitative study aimed to identify perspectives from collaborators on barriers and facilitators that impact the implementation of a PLDSMS intervention for older Black men with T2D. Methods Qualitative data were collected as part of the Michigan Men’s Diabetes Project. We used the Tailored Implementation in Chronic Diseases (TICD) Checklist to construct the semi-structured interview guide. TICD domains served as themes. Codes were later generated as a team (N = 3) from chunks of related text. Eight 1-on-1 semi-structured interviews (two researchers, three peer leaders, one community collaborator, two certified diabetes care and education specialists) were conducted between April 13–22, 2022 via Zoom. We engaged in thematic content analysis and used the rigorous and accelerated data reduction (RADaR) technique and Rapid analysis. Results Themes included guideline factors; individual collaborator factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; and use of technology. Guidelines for implementing a PLDSMS program for Black men with T2D are lacking. For effective implementation, collaborators need interpersonal and session facilitation skills, flexibility, and cultural awareness. Although Black men with T2D may initially be apprehensive about participating in a PLDSMS program due to lack of knowledge, masculine norms, and stigma, these programs offer a safe space, a sense of brotherhood, and transparency. Having a physician champion is key in supporting organizational changes needed to implement PLDSMS programs in health systems, particularly as PLDSMS is not currently a billable service. Conclusions The PLDSMS program is culturally relevant in engaging older Black men with T2D. In addition to building trust among participants, successful development and implementation of a peer support program requires flexibility and tailored communication strategies. Findings can be used to inform future iterations of PLDSMS programs.