title: Peer Coaches to Improve Diabetes Outcomes in Rural Alabama: A Cluster Randomized Trial.
abstract: OBJECTIVE
  It is unclear whether peer coaching is effective in minority populations living with diabetes in hard-to-reach, under-resourced areas such as the rural South. We examined the effect of an innovative peer-coaching intervention plus brief education vs brief education alone on diabetes outcomes.
  
  
  METHODS
  This was a community-engaged, cluster-randomized, controlled trial with primary care practices and their surrounding communities serving as clusters. The trial enrolled 424 participants, with 360 completing baseline and follow-up data collection (84.9% retention). The primary outcomes were change in glycated hemoglobin (HbA1c), systolic blood pressure (BP), low density lipoprotein cholesterol (LDL-C), body mass index (BMI), and quality of life, with diabetes distress and patient activation as secondary outcomes. Peer coaches were trained for 2 days in community settings; the training emphasized motivational interviewing skills, diabetes basics, and goal setting. All participants received a 1-hour diabetes education class and a personalized diabetes report card at baseline. Intervention arm participants were also paired with peer coaches; the protocol called for telephone interactions weekly for the first 8 weeks, then monthly for a total of 10 months.
  
  
  RESULTS
  Due to real-world constraints, follow-up was protracted, and intervention effects varied over time. The analysis that included the 68% of participants followed up by 15 months showed only a significant increase in patient activation in the intervention group. The analysis that included all participants who eventually completed follow-up revealed that intervention arm participants had significant differences in changes in systolic BP (P = .047), BMI (P = .02), quality of life (P = .003), diabetes distress (P = .004), and patient activation (P = .03), but not in HbA1c (P = .14) or LDL-C (P = .97).
  
  
  CONCLUSIONS
  Telephone-delivered peer coaching holds promise to improve health for individuals with diabetes living in under-resourced areas.
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama msafford@uab.edu.
authors: Monika M
authors: MM
authors: Safford
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Susan
authors: S
authors: Andreae
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Andrea L
authors: AL
authors: Cherrington
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Michelle Y
authors: MY
authors: Martin
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Jewell
authors: J
authors: Halanych
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Marquita
authors: M
authors: Lewis
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Ashruta
authors: A
authors: Patel
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama West Central Alabama Community Health Improvement League, Camden, Alabama.
authors: Ethel
authors: E
authors: Johnson
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama Sumter County Health and Wellness Education Center, Livingston, Alabama.
authors: Debra
authors: D
authors: Clark
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Christopher
authors: C
authors: Gamboa
authors: Birmingham VA Medical Center, Birmingham, Alabama Department of Surgery, University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.
authors: Joshua S
authors: JS
authors: Richman
mesh_terms: D000368:Aged; D000407:Alabama; D001794:Blood Pressure; D015992:Body Mass Index; D008078:Cholesterol, LDL / Q000097:blood; D016000:Cluster Analysis; D003376:Counseling / Q000379:methods*; D003920:Diabetes Mellitus / Q000097:blood / Q000523:psychology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010379:Peer Group; D011788:Quality of Life; D012424:Rural Population; D012648:Self Care / Q000379:methods* / Q000523:psychology; D012944:Social Support; D013689:Telephone; D016896:Treatment Outcome; D035862:Vulnerable Populations
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Peer health coaching; diabetes; primary care; self-management support