The Specific Aim of this proposal is to test the feasibility of developing, utilizing, and evaluating a web-based diabetes self-management support (DSMS) training program that is culturally tailored for the African American community. Effective self-management is the key to improving diabetes outcomes, avoiding complications, and reducing costs. Ongoing maintenance of self-management is particularly challenging among many African- Americans. Diabetes self-management education (DSME) was developed to address this critical gap in self- management support. When culturally tailored, DSME can be particularly effective in African American communities. However, the impact of DSME is not long lasting. Ongoing diabetes self-management support (DSMS) after DSME has been used to sustain the positive effects of DSME. Peer mentors (trained lay individuals successfully managing their own diabetes) are an affordable and effective means of delivering DSMS. Peer mentors are currently trained in-person, which greatly limits the number of peer mentors that can be trained due to lack of scalability of such training. Thus we propose the development and evaluation of a web-based DSMS training of peer mentors in lieu of in-person training. To achieve our Phase I Specific Aim, we will carry out four Tasks: Task 1: Conduct focus groups: We will conduct two focus groups with 6 uncontrolled diabetes patients each and two focus groups with 6 diabetes peer mentors each. The goal is to understand how to translate the African American-tailored in-person training material into an effective web-based program. Task 2: Develop DSMS Training Program Prototype for Peer Mentors: 12 web-based, e-Learning modules and assessments will be created based on the modules developed and proven effective by Tang et al. (2011). Task 3. Evaluate Peer Training Efficacy with 24 Subjects. Recruit 30 diabetes peer mentor candidates to complete the web-based training and evaluations; accounting for 20% attrition. Training Criteria to be Met: More than 80% of mentors must pass all of the individual passing criteria: 1) >80% score on the Diabetes Knowledge Test, >80% score on the Diabetes Knowledge Questionnaire, and mean score of >4 on the Understanding Management Practice scale; (2) +2 on 3 of the 6 empowerment-based vignettes and at least +1 on the remaining 3 vignettes; (3) >4 on Self-Efficacy Survey; (4) passing score in Goal-Setting Simulation; and a (5) mean score >4 on an adapted version of the Active Listening Observation Scale. Task 4. Evaluate Feasibility of DSMS Delivered by Peer Mentors: A two-arm randomized clinical trial will assess the feasibility of using web-trained peer mentors to deliver DSMS after DSME in the African American community. Test of Feasibility: We expect a 1% difference in HbA1c reduction to be sustained at 6 months. Phase II Plans: Develop a set of similar products for multiple diversity groups and conduct a large multi-arm randomized clinical trial to test efficacy of peer-delivered DSMS to support commercialization of the product.
Diabetes Self-Management Education (DSME) is a proven means of helping improve diabetes metabolic control; however, the positive impact on health outcomes diminishes with time. Therefore, both the American Diabetes Association (ADA) and the American Association of Diabetes Educators (AADE) recommend that Diabetes Self-Management Support (DSMS) complement DSME. Peer mentors (trained lay individuals successfully managing their own diabetes) are a cost-effective means of delivering DSMS. InquisitHealth's proposed web-based peer mentor training and mentor management system is a means of scaling DSMS widely and with cultural relevance.
