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

描述(申请人提供)：如果没有持续的跟踪和支持，专业主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。考虑到资源的限制，同行主导的干预是维持自我管理努力和在短期DSME计划中实现的健康收益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是持续的、患者驱动的、对变化做出反应并嵌入现有社区基础设施的。非裔美国人(AA)教堂是提供以社区为基础的、同行领导的健康促进干预措施的潜在有效场所。本研究建议对同辈领袖进行培训，以促进理论驱动的、基于赋权的干预，并试行以教会为基础、同辈领导的自我管理支持干预，以小组形式提供。具体目标是：(1)确定从密歇根州大伊普西兰蒂地区10个再生障碍性贫血教会招募的PLS培训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；以及(3)通过估计干预引起的A1C变化的影响大小以及A1C与其他结果的组内相关性，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，并向他们提供知识和技能，以促进持续的糖尿病自我管理支持(DSM)干预。请满足预先设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面试(MI)的沟通技能。在第二阶段，我们将使用单组重复措施设计进行为期12个月的CBPL干预，其中包括3个月的DSME培训和9个月的持续DSMM。参与者将从密歇根州大伊普西兰蒂地区的10个AA教堂招募。在以教会为基础的环境中，利用同伴领袖促进以赋权为基础的干预，可能会成为“真实世界”环境中持续自我管理支持的一种可行和可持续的模式。 公共卫生相关性：如果没有持续的跟踪和支持，专业主导的糖尿病自我管理教育计划只会在短期内改善糖尿病相关的健康结果。持续糖尿病自我管理支持(DSM)的可持续模式是必要的，应该是持续的、患者驱动的、对变化的反应，并嵌入到现有的社区基础设施中。培训同辈领袖以促进理论驱动的、基于赋权的DSM干预在教会环境中可能是一个可行和有前途的方法。

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.