Training peers to deliver ongoing self-management support in church-based setting

描述（由申请人提供）：如果没有持续的随访和支持，专业主导的糖尿病自我管理教育（DSME）干预措施只能对改善糖尿病相关结果产生短期影响。鉴于资源限制，同行主导的干预措施是维持自我管理努力和短期 DSME 计划中取得的健康成果的一种有前途的方法。然而，可持续的自我管理支持模式需要持续、以患者为主导、对变化做出响应，并嵌入现有的社区基础设施中。非裔美国人 (AA) 教会是提供基于社区、同伴主导的健康促进干预措施的潜在有效场所。本研究建议培训同伴领袖 (PL)，以促进理论驱动、基于赋权的干预措施，并在团体环境中试点以教会为基础、同伴主导 (CBPL) 的自我管理支持干预措施。具体目标是：(1) 确定对从密歇根州大伊普西兰蒂地区 10 个 AA 教会招募的 PL 进行培训的可行性和可接受性，以促进基于授权的自我管理支持干预措施，(2) 确定对患有 2 型糖尿病的 AA 进行为期 12 个月的 CBPL 干预的可行性和可接受性，以及 (3) 通过估计变化的影响大小，建立设计和推动 CBPL 干预有效性研究所需的参数估计值由于干预以及 A1C 和其他结果的组内（组内）相关性，A1C 的变化。在第一阶段，我们将实施一项为期 12 周的培训计划，从 10 个 AA 教会招募患有 2 型糖尿病的成年人，并为他们配备知识和技能，以促进持续的糖尿病自我管理支持 (DSMS) 干预。 PL 必须满足预先制定的基于能力的标准才能成功毕业。基于能力的领域包括糖尿病相关知识、基于赋权的促进技能和基于动机访谈 (MI) 的沟通技巧。在第二阶段，我们将采用单组重复测量设计进行为期 12 个月的 CBPL 干预，其中包括 3 个月的 DSME 培训，随后是 9 个月的持续 DSMS。参与者将从密歇根州大伊普西兰蒂地区的 10 个 AA 教会中招募。利用同伴领袖在教会环境中促进基于赋权的干预措施可以作为在“现实世界”环境中持续自我管理支持的可行且可持续的模式。 公众健康相关性：如果没有持续的跟进和支持，专业主导的糖尿病自我管理教育计划只能在短期内改善与糖尿病相关的健康结果。持续的糖尿病自我管理支持（DSMS）的可持续模式是必要的，并且应该是持续的、以患者为主导的、对变化做出响应的，并嵌入现有的社区基础设施中。培训同伴领袖以促进在教会环境中进行理论驱动、基于授权的 DSMS 干预可能是一种可行且有前途的方法。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: 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.