title: The effectiveness of peer health coaching in improving glycemic control among low-income patients with diabetes: protocol for a randomized controlled trial.
abstract: BACKGROUND
  Although self-management support improves diabetes outcomes, it is not consistently provided in health care settings strained for time and resources. One proposed solution to personnel and funding shortages is to utilize peer coaches, patients trained to provide diabetes education and support to other patients. Coaches share similar experiences about living with diabetes and are able to reach patients within and beyond the health care setting. Given the limited body of evidence that demonstrates peer coaching significantly improves chronic disease care, this present study examines the impact of peer coaching delivered in a primary care setting on diabetes outcomes.
  
  
  METHODS
  The aim of this multicenter, randomized control trial is to evaluate the effectiveness of utilizing peer coaches to improve clinical outcomes and self-management skills in low-income patients with poorly controlled diabetes. A total of 400 patients from six primary health centers based in San Francisco that serve primarily low-income populations will be randomized to receive peer coaching (n = 200) or usual care (n = 200) over 6 months. Patients in the peer coach group receive coaching from patients with diabetes who are trained and mentored as peer coaches. The primary outcome is change in HbA1c. Secondary outcomes include change in: systolic blood pressure, body mass index (BMI), LDL cholesterol, diabetes self-care activities, medication adherence, diabetes-related quality of life, diabetes self-efficacy, and depression. Clinical values (HbA1c, LDL cholesterol and blood pressure) and self-reported diabetes self-efficacy and self-care activities are measured at baseline and after 6 months for patients and coaches. Peer coaches are also assessed at 12 months.
  
  
  CONCLUSIONS
  Patients with diabetes, who are trained as peer health coaches, are uniquely poised to provide diabetes self management support and education to patients. This study is designed to investigate the impact of peer health coaching in patients with poorly controlled diabetes. Additionally, we will assess disease outcomes in patients with well controlled diabetes who are trained and work as peer health coaches.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01040806.
authors: Department of Family and Community Medicine, University of California, San Francisco (UCSF), 995 Potrero Ave, Building 80/83, San Francisco, CA 94110, USA. ghoroba@fcm.ucsf.edu
authors: Amireh
authors: A
authors: Ghorob
authors: Maria Mercedes
authors: MM
authors: Vivas
authors: Diana
authors: D
authors: De Vore
authors: Victoria
authors: V
authors: Ngo
authors: Thomas
authors: T
authors: Bodenheimer
authors: Ellen
authors: E
authors: Chen
authors: David H
authors: DH
authors: Thom
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D002985:Clinical Protocols; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods*; D010379:Peer Group; D011203:Poverty; D011320:Primary Health Care / Q000379:methods*; D012495:San Francisco; D012648:Self Care; D012944:Social Support; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin