Without continued follow-up and support, professionally-led diabetes self-management education (DSME) interventions only have a short-term impact on improving diabetes-related outcomes. In light of resource constraints, peer-led interventions are a promising approach to sustain self-management efforts and health gains achieved in short-term DSME programs. However, sustainable models of self-management support need to be ongoing, patient-driven, responsive to change, and embedded in existing community infrastructures. African-American (AA) churches are a potentially effective venue for delivering community- based, peer-led health promotion interventions. This study proposes to train Peer Leaders (PLs) to facilitate a theoretically-driven, empowerment-based intervention and pilot a church-based, peer-led (CBPL) self- management support intervention delivered in a group setting.
Specific aims are: (1) to determine the feasibility and acceptability of training PLs recruited from 10 AA churches in the greater Ypsilanti, Michigan area to facilitate an empowerment-based self-management support intervention, (2) to determine the feasibility and acceptability of conducting a 12-month CBPL intervention for AAs with type 2 diabetes, and (3) to establish estimates of parameters needed to design and power a study of the effectiveness of the CBPL intervention by estimating the effect size of the change in A1C due to the intervention and the intraclass (within group) correlation of A1C and other outcomes. In Phase I, we will implement a 12-week training program recruiting adults with type 2 diabetes from 10 AA churches and equipping them with the knowledge and skills to facilitate an ongoing diabetes self-management support (DSMS) intervention. PLs must fulfill the pre-established competency-based criteria to successfully graduate. Competency-based areas include diabetes-related knowledge, empowerment-based facilitation skills, and motivational interviewing (MI)-based communication skills. In Phase II, we will use a single-group repeated measures design to conduct a 12-month CBPL intervention with 3 months of DSME training followed by 9 months of ongoing DSMS. Participants will be recruited from the 10 AA churches in the greater Ypsilanti, Michigan area. Using peer leaders to facilitate empowerment-based interventions in church-based settings may serve as a viable and sustainable model for ongoing self-management support in "real-world" settings.
Without continued follow-up and support, professionally-led diabetes self-management education programs only improve diabetes-related health outcomes in the short-term. Sustainable models of ongoing diabetes self- management support (DSMS) are needed and should be ongoing, patient-driven, responsive to change, and embedded in existing community infrastructures. Training peer leaders to facilitate theory-driven, empowerment-based DSMS interventions in church-based settings may be a viable and promising approach.