Technologically Enhanced Coaching: A Program to Improve Diabetes Outcomes
Condition: Diabetes
MeSH terms: Diabetes Mellitus
Study type: Interventional

Summary: 
      Peer support programs have been demonstrated to improve glycemic control among Veterans with
      poor control. This program will expand on this success by putting innovative tools in the
      hands of Veteran diabetes patients. Veteran coaches who have demonstrated effective control
      of their own diabetes will be trained to use communication skills to guide their peers
      through a diabetes education and decision aid. This tool, which is an iPad application, draws
      the patient in by showing them their personal risk and medication information derived from
      baseline labs and self-reported survey data. The tool encourages interaction by providing
      choices of materials to view, using audio-visual elements and incorporating a goal-setting
      process for developing self-management action steps and questions to discuss with their
      doctor at their next clinic visit. Ongoing weekly contact between the Veterans is supported
      by a confidential phone system.
    

Detailed description: 
      Peer mentoring and support models have been found in two recent VA Randomized Controlled
      Trials (RCTs) to be more effective than usual care, financial incentives, and usual nurse
      care management to improve glycemic control in high-risk Veteran patients with poor glycemic
      control. Such models are important complements to provision of care by formal health care
      providers as they provide sustained, flexible between-visit support. Peer supporters and
      coaches can be trained in effective behavioral approaches to support other Veterans'
      self-management behaviors. Such supporters, however, necessarily lack the content expertise
      to help Veterans make informed treatment decisions and set health goals with their health
      care providers. Accordingly, in a recent study the investigators developed and tested a
      tailored, interactive computer-based tool with diabetes and medication information embedded
      in the tool's software that peer coaches and other outreach workers can employ to facilitate
      discussions with patients. Such tailored, interactive tools have been found to be more
      effective than generic educational and decision support tools in improving clinical and
      patient-centered outcomes. Moreover, these tools could enhance the sustainability and
      effectiveness of coaching programs to better prepare patients to set self-management goals
      and action plans, and to discuss treatment options with their health care providers. With VA
      support and input from Veterans, the investigators adapted the tailored, interactive
      computer-based tool for use with and by Veterans with diabetes. The investigators now propose
      to incorporate this tool into a peer mentor-led diabetes self-management coaching program
      among predominantly African American Veterans with poor glycemic control at the Detroit VA, a
      VA health system with high rates of poor risk factor control among diabetes patients. The
      investigators propose to evaluate this Technology-Enhanced Coaching (TEC) program.
      Specifically, the investigators propose to:

      Aim 1: Test the effectiveness of a technology-enhanced peer coaching (TEC) program in
      improving glucose control relative to peer coaching without technology enhancement; and, also
      test the effectiveness of peer support compared to observed usual care. For the "usual care"
      observed group, the investigators will use electronic health record data to measure A1c
      levels.

      Aim 2: Assess the impact of the intervention on key patient-centered outcomes, including
      patients' satisfaction and involvement with care, perceived social support, diabetes-specific
      quality of life, and medication adherence.

      Aim 3: Identify patient characteristics associated with engagement in the intervention and
      mediators and moderators of the intervention's impact on patient outcomes.

      In summary, the TEC program builds on the demonstrated strengths of peer support models and
      of tailored, interactive decision support tools in improving diabetes self-management and
      outcomes. This study will test incorporation of tailored interactive educational tools into a
      peer coaching model found in prior VA RCTs to be effective in improving diabetes outcomes.

      The tools tested in the proposed intervention will be disseminated for use in other VA sites
      through a tool kit with training and support materials. Because the intervention addresses
      barriers to disease management for chronically ill patients, physicians, and case managers,
      the study may have broader impact on management practices for other chronic illnesses.
    

Intervention name(s): Peer Coaching; Decision Aid
Intervention type(s): Behavioral; Behavioral
Intervention description(s): All participants will be assigned to a peer coach, who is a Detroit VA diabetes patient who previously had poor glycemic control but is currently in good control. Participants will receive information on their lab and blood pressure values and will be scheduled for an initial visit with their coach. The coach will then help them list questions and concerns they wish to discuss with their health care provider, practice raising their questions and concerns, and develop an action plan to address barriers to self-management they have identified. During the next six months, coaches will call their assigned peers once a week to provide support for their action steps.; The iDecide tool is designed to present key tailored, evidence-based information on diabetes and diabetes treatments. Importantly for a peer support intervention, all content information will be provided through the tool, with the role of the peer mentor being to assist the participant to go through the program and participate in helping the patient formulate questions and concerns to discuss with their health care provider, to set their own behavioral goals and action steps, and to help the participant practice raising the issues they plan to discuss with their health care provider.
Other intervention name(s): TEC
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Health Services Research
Keywords: Peer Support; Self Management; Health Disparities