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，专业指导的糖尿病自我管理教育（DSME）干预只能对改善糖尿病相关结果产生短期影响。鉴于资源限制，同伴主导的干预措施是一种有希望的方法，以维持自我管理努力和短期DSME计划中取得的健康收益。然而，可持续的自我管理支持模式需要持续进行，以患者为导向，对变化作出反应，并嵌入现有的社区基础设施。非裔美国人（AA）教会是提供以社区为基础、以同伴为主导的健康促进干预的潜在有效场所。本研究建议培训同伴领导（PLs），以促进理论驱动的、基于赋权的干预，并试点以教会为基础的、以同伴为主导的（CBPL）自我管理支持干预。具体目标是：(1)确定从密歇根州大Ypsilanti地区的10个AA教会招募的培训PLs的可行性和可接受性，以促进基于赋权的自我管理支持干预；(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；(3)通过估计干预引起的糖化血红蛋白变化的效应大小以及糖化血红蛋白与其他结果的类内（组内）相关性，建立设计和推动CBPL干预有效性研究所需的参数估计。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教堂招募2型糖尿病成年人，并为他们提供知识和技能，以促进持续的糖尿病自我管理支持（DSMS）干预。PLs必须履行预先建立的能力为基础的标准，成功毕业。基于能力的领域包括糖尿病相关知识、基于授权的促进技能和基于动机性访谈（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3个月的DSME培训，随后9个月的持续DSMS。参加者将从密歇根州大伊普斯兰蒂地区的10个AA教堂中招募。在“现实世界”的环境中，利用同伴领导促进基于赋权的干预可能是一种可行和可持续的自我管理支持模式。

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.