The value of peer support for self-management of diabetes among veterans in the Empowering Patients In Chronic care intervention

Telehealth Walking Self-Management for Individuals With Amputation: A Qualitative Study of Therapist Perspectives on Adoption

OBJECTIVE

The aim of this study was to understand therapist-identified factors influencing clinical adoption of a telehealth walking self-management intervention for individuals with lower limb amputation.

METHODS

Semi-structured focus groups were completed with actively practicing physical and occupational therapists treating populations that are medically complex. A qualitative explorative design was employed with conventional content analysis and iterative independent parallel coding using 2 analysts. Themes and subthemes were generated with a consensus building process identifying patterns and collapsing codes to represent participant perspectives.

RESULTS

Thematic saturation was met after 5 focus groups (24 therapists). Therapists were on average 34 years old and predominantly female (n = 19; 79%) physical therapists (n = 17; 71%). Three primary facilitator and barrier themes were identified for intervention adoption: system, therapist, and person. System considerations included telehealth support and interprofessional care coordination. Therapist facilitators included self-management programming that overlapped with standard of care and personalization methods. However, limited behavioral theory training was a therapist level barrier. Finally, person factors such as patient activation could influence both positively and negatively. Person facilitators included social support and barriers included the complex health condition.

CONCLUSION

System, therapist, and person facilitators and barriers must be considered to maximize the adoption of similar telehealth walking self-management interventions and prior to larger scale implementation of the current intervention for individuals with lower limb amputation.

IMPACT

A telehealth walking self-management intervention has potential impact for individuals with lower limb amputation and must be considered in terms of optimizing system, therapist, and person level facilitators and barriers to implementation.

Exploring Reasons for Non-Engagement From a Peer-Led Diversionary Intervention for Veterans in Police Custody

UK veterans with complex needs arrested in police custody can access support through pre-charge diversion into treatment and ancillary services. We consider why veterans in police custody disengaged from a peer-led criminal justice diversionary support service in one UK region that adopted a continuous case management approach. Seven hundred and fifty-seven veterans were assessed to have high levels of comorbid health needs and socio-economic harms, with one-quarter (26.7%, n = 202) subsequently disengaging from the service. A logistic regression model using Multivariate Imputation by Chained Equations identified that veterans of a younger age, no-fixed-abode, a history of incarceration, and those from a Royal Navy background were likelier to disengage from the intervention. We conclude that this peer-based diversionary model has some efficacy in maintaining the engagement of a highly complex, comorbid segment of criminally-justice-exposed UK military veterans. The perceived benefits of an integrated peer-based model predicated on continuous case-management techniques are discussed.

Peer Support Activities for Veterans, Serving Members, and Their Families: Results of a Scoping Review

For many, including military veterans and their families, support between individuals with shared lived experiences, or peer support, has long been utilized as a way to support each other through many different challenges. Building on other reviews and guided by the seven domains of well-being in the Canadian veteran well-being framework, the objective of this paper is to describe and catalogue the nature of peer support activities and related outcomes in the veteran, serving member, and family member populations. A scoping review following the five stages outlined by Arksey and O'Malley was conducted; it was guided by the question: What is currently known about peer support activities for veterans, serving members, and their families that has been evaluated in the literature? In total, 101 publications from 6 different countries were included in this review and catalogued based on publication characteristics, participant information, peer support activity information, and peer information. Peer support activities have the potential to positively influence the well-being of veterans, serving members, and their families on a holistic level across multiple domains. This scoping review highlights the existing gaps in the literature and provides an important foundation for future research on peer support for these populations, specifically in the Canadian context.

"A reinstilled hope that they can change": Facilitator perspectives on a self-care and health promotion peer group program for veterans

Introduction

This study assessed the relevance, value, and effectiveness of "Taking Charge of My Life and Health" (TCMLH), a patient wellbeing peer group program for U.S. veterans focused on empowering them to identify what really matters in their lives and to work toward health goals that align with their mission, aspirations, or purpose in life. The potential of TCMLH to empower veterans to engage in self-care behaviors, make health behavior changes, and participate in health care decision making is important, as veterans are more likely than the general population to suffer from multiple chronic conditions that require ongoing self-management.

Methods

We conducted individual semi-structured interviews with 19 TCMLH facilitators serving in eight U.S. Veteran's Health Administration medical centers. Data were analyzed using an inductive approach to identify salient themes in facilitators' experiences.

Results

Facilitators reported that TCMLH participants demonstrated positive attitude changes (e.g., greater confidence and hope) and behavior changes (e.g., making healthcare appointments and implementing self-care practices) by program completion. Further, findings show that mindful awareness practices, the peer group setting, Whole Health assessment tools, and goal setting tools were perceived as the most impactful program elements leading to positive health behavior change.

Conclusion

Overall, findings suggest that this non-clinical peer group program can enhance patient wellbeing, and that there are certain program elements of TCMLH that are driving key attitudinal and behavioral changes.

From clinic to community: A randomized controlled trial of a peer support model for adults with type 2 diabetes from specialty care settings in British Columbia

AIMS

To examine the impact of a 12-month peer-led diabetes self-management support intervention delivered via telephone amongst adults with type 2 diabetes (T2D) from specialty care settings in British Columbia (BC).

METHODS

One-hundred ninety-six adults with T2D were randomly assigned to either a 12-month Peer-Led, Empowerment-based, Approach, to Self-management Efforts in Diabetes (PLEASED) intervention or a usual care condition. PLEASED involved weekly telephone contacts from a peer leader (PL) in the first 3 months followed by bi-weekly telephone contacts in the last 9 months. Assessments were conducted at baseline, 3 and 12 months. The primary outcome was HbA_1c ; secondary outcomes included diabetes distress (DD), ApoB, systolic and diastolic blood pressure (BP), body mass index, waist circumference and depressive symptoms.

RESULTS

No within or between group changes were observed for HbA_1c at 3 or 12 months. However, amongst participants with HbA_1c  ≥ 69 mmol/mol (8.5%), the PLEASED group significantly lowered their HbA_1c at 12 months [-11.7 mmol/mol (-1.07%); 95% CI: -20.7, -2.5 (-1.89, -0.23); p = 0.016] compared to usual care. Amongst secondary outcomes, within-group improvements in overall DD were found at 3 months (-0.21; 95% CI: -0.35, -0.08; p = 0.002) for the PLEASED group and at 12 months for both groups (PLEASED: -0.35; 95% CI: -0.49, -0.21; p < 0.001 and control: -0.33; 95% CI: -0.47, -0.19; p < 0.001), however, no between-group differences were observed. The PLEASED group improved systolic BP at 12 months (-5.4 mm Hg; 95% CI: -10.0, -0.8; p = 0.023) compared to usual care.

CONCLUSIONS

Participation in a peer support intervention in diabetes delivered via telephone leads to long-term improvements in HbA1c amongst high-risk adults with T2D living in BC.

TRIAL REGISTRATION

The study was registered on clinicaltrials.gov (NT02804620).

Type 2 diabetes peer support interventions as a complement to primary care settings in high-income nations: A scoping review

OBJECTIVES

Inadequate social support make way for peer support initiatives to complement the health system delivery of diabetes self-management education programs for type 2 diabetes (T2D). This review synthesizes knowledge about T2D peer support in terms of their various models and impact, endorsement, and contextual information in high-income nations.

METHODS

A scoping review was conducted on published and grey literature in four electronic bibliographic databases between January 2007 to December 2021.

RESULTS

76 records were included. Face-to-face self-management programs and telephone-based peer support seem the most promising modalities given the largest scientific coverage on T2D outcomes. Face-to-face self-management programs were the most preferred by ethnic minority groups. Unlike peer supporters, healthcare professionals had mixed views about T2D peer support interventions. Managers of peer support programs perceived cultural competency as a cornerstone for peer support implementation. Care must be taken in recruiting, training and retaining peer supporters for sustainable practice.

CONCLUSIONS

Various T2D peer support models lie at the interface between primary care and community-based settings.

PRACTICE IMPLICATIONS

Fostering the role of peer support beyond healthcare organizations should be encouraged to engage the hardly reached, and to leverage community support to complement the health system.

Religion, support and self-care experiences: A qualitative descriptive study with Indonesian adults with the chronic disease living in Montreal, Canada

AIM

To explore and describe the chronic illness self-care experiences of Indonesian immigrants living in Montreal, Canada and to gain a better understanding of how religion and support shaped these experiences.

DESIGN

Qualitative description.

METHODS

Data were collected from January to March 2020 via semi-structured interviews. Eight men and women participated. The data were thematically analysed.

RESULTS

Major themes identified were (1) religion, (2) being helpful to others, (3) family support, (4) transnational family support, (5) community support and (6) being in Indonesia versus Canada. Religion and faith were sources of motivation for self-care and provided guidance and strength to heal and accept the illness, mainly through the practice of prayer. 'Being helpful to others' (collectivism), including aiding others to avoid getting sick or giving 'health tips', and also just generally taking care of family also contributed to overall well-being. Spouses were the main source of assistance with disease monitoring and management and health maintenance, whereas support from the Indonesian community was minimal and mostly consisted of informational and social support. Transnational relationships with family members in Indonesia, however, provided an additional means for obtaining emotional support, advice and access to traditional medicines. Overall, there was little expectation that family or the community offer or provide support with self-care. These low expectations may partially be explained by the different cultural and social contexts in Canada compared with Indonesia.

CONCLUSION

Religious, cultural, social and family factors may be carried over from the home country and/or may be altered post-migration, and this may impact how Indonesian immigrants with chronic illness engage in self-care.

IMPACT

Cultural factors (collectivism, traditional medicines), religious beliefs and support networks, both locally and transnationally should be assessed and considered during care to better support and promote self-care among immigrants living with chronic diseases.

PATIENT OR PUBLIC CONTRIBUTION

Two Indonesian community organizations facilitated recruitment and data collection.

To support self-management for people with long-term conditions - The effect on shared decision-making, empowerment and coping after participating in group-learning sessions

Introduction

Interventions that support patients to handle the emotional and medical aspects of a long‐term health condition is important. One way is to use peer‐support groups, to help patients solving problems, increasing their knowledge and making decisions.

Aim

was to investigate the impact on shared decision‐making, empowerment and coping after participation in group‐learning sessions for patients with long‐term conditions (N = 42).

Design

An intervention following a health education programme based on group‐learning sessions was established. Eight different programmes were held in five different departments at a regional county hospital in Sweden.

Methods

Questionnaires were analysed using paired‐sample t‐test.

Results

Results showed that patients might have better opportunities to be more active during their patient encounter after attending the group learning sessions. Interventions directed to patient activation may be one key in future healthcare management, especially concerning long‐term conditions. Empowering patients is central in healthcare, and using different approaches is important.

'It's the empathy'-defining a role for peer support among people living with chronic kidney disease: a qualitative study

OBJECTIVES

Persons with advanced chronic kidney disease (CKD) have unique support needs associated with managing a chronic yet often silent condition, complex treatment-related decisions and care transitions. The aim of this study was to explore perspectives on how peer support could address CKD support needs and augment care.

DESIGN

This study employed a qualitative descriptive methodology. Data were collected through focus groups (cofacilitated by patient partners) and semistructured interviews.

SETTING

Four multidisciplinary CKD clinics across Southern Alberta, Canada.

PARTICIPANTS

We purposively sampled among adult patients with advanced, non-dialysis CKD and their caregivers, as well as trained peer mentors from The Kidney Foundation of Canada's Kidney Connect programme.

ANALYSIS

Transcripts were coded in duplicate, and themes were generated inductively through a thematic analysis approach.

RESULTS

We conducted seven focus groups with a total of 39 patient and caregiver participants. Seven patients and caregivers who were unable to attend a focus group and 13 peer mentors participated in a telephone interview. Although patients and caregivers had limited awareness of peer support, participants acknowledged its central role in affirming their experiences and enabling confidence to live well with kidney disease. We identified four themes related to the anticipated role of peer support in addressing support needs for people with non-dialysis CKD: (1) creating connection; (2) preparing for uncertainty; (3) adapting to new realities; and (4) responsive peer support delivery. Aligning peer support access with patient readiness and existing CKD management supports can promote optimism, community and pragmatic adaptations to challenges.

CONCLUSIONS

Patients, caregivers and peer mentors highlighted a unique value in the shared experiences of CKD peers to anticipate and manage disease-related challenges and confidently face a future living with kidney disease.

Living Kidney Donation Stories and Advice Shared Through a Digital Storytelling Library: A Qualitative Thematic Analysis

Rationale & Objective

Despite the development of numerous educational interventions, there has been limited change in actual living donor kidney transplant (LDKT) rates over time. New strategies, such as the inclusion of patient stories in patient education, show promise to inspire more people to donate kidneys. This study identified the challenges faced, coping strategies used, and advice shared by transplant donors and recipients.

Study Design

Qualitative thematic analysis.

Setting & Participants

One hundred eighteen storytellers across the United States and Canada, including 82 living donors and 36 kidney recipients of living donor transplants who shared their stories on the Living Donation Storytelling Project (explorelivingdonation.org), an online digital storytelling platform and library.

Analytical Approach

A poststorytelling survey assessed participant demographics. Two coders conducted tool-assisted (Dedoose v.8.3.35) thematic analysis on narrative storytelling videos and transcripts.

Results

Storytellers were predominantly White (79/118, 66.95%), female (76/118, 64.41%), and non-Hispanic (109/118, 92.37%) with college/vocational education (50/118, 42.37%). Common themes were found related to living donation challenges for donors and recipients (eg, the fear of not being able to complete the LDKT process, of unsupportive family or rejected donation requests, and of unknown or adverse surgical outcomes and graft rejection) and recommended coping strategies (eg, seeking LDKT information, using prayer, and relying on a support network). Recipients provided advice that included being proactive and staying hopeful, whereas donors recommended seeking support, researching LDKT to comprehensively learn, and building a community of support.

Limitations

Limited representation of diverse demographics.

Conclusions

Although supplementary to traditional education about LDKT, digital storytelling provides a source of peer support that can enhance the experience of donors and recipients and encourage autonomy and self-management after transplant.

A Focus Group Study of Self-Management in Patients With Glomerular Disease

INTRODUCTION

Patients with glomerular disease experience symptoms that impair their physical and mental health while managing their treatments, diet, appointments and monitoring general and specific indicators of health and their illness. We sought to describe the perspectives of patients and their care partners on self-management in glomerular disease.

METHODS

We conducted 16 focus groups involving adult patients with glomerular disease (n = 101) and their care partners (n = 34) in Australia, Hong Kong, the United Kingdom, and United States. Transcripts were analyzed thematically.

RESULTS

We identified the following 4 themes: empowered in autonomy (gaining confidence through understanding, taking ownership of disease and treatment, learning a positive health approach); overwhelmed by compounding treatment burdens (financially undermined and depleted, demoralized by side effects and harms, frustrated by fragmented and inflexible care, fear of possible drug harms); striving for stability and normalcy (making personal sacrifices, maximizing life participation, attentiveness to bodily signs, avoiding precarious health states, integrating medicines into routines); and necessity of health-sustaining relationships (buoyed by social support, fulfilling meaningful responsibilities, sharing and normalizing experiences, seeking a trusting and respectful alliance).

CONCLUSION

Patients with glomerular disease and their care partners value their capacity for autonomy and disease ownership, stability of their health, and relationships that support self-management. Strategies directed at strengthening these factors may increase self-efficacy and improve the care and outcomes for patients with glomerular disease.

Beneficial effects on body weight of group vs individual care in adults with type 1 diabetes on advanced technologies

RATIONALE AND AIMS

Outpatient group visits in diabetes care have several potential advantages and can be simplified by the new technologies. The aim of this study was to assess feasibility and effectiveness of group visits vs individual visits in adults with type 1 diabetes on insulin pump therapy (continuous subcutaneous insulin infusion, CSII) and continuous glucose monitoring (CGM).

METHODS

Outpatient setting for group visits (2-hour duration, quarterly, 6-8 patients) was the projection on giant screen of each patient's CGM and insulin pump data, with interactive discussion moderated by a diabetologist. Anthropometric measures and glycemic control (HbA1c) were assessed before and after a mean observation period of 4.4 ± 1.2 years (mean ± standard deviation, M ± SD) in CSII patients followed by group visits (GROUP) or individual visits (INDIVIDUAL) between 2013 and 2019.

RESULTS

At the beginning of the observation, GROUP and INDIVIDUAL cohorts were strictly matched for gender (M/F = 37/35 and 37/35), age, diabetes duration, body mass index (BMI), CSII duration, and HbA1c level. HbA1c levels did not change significantly between beginning and end of observation in either cohort (GROUP 7.54 ± 0.80% and 7.60 ± 0.79%, P = .585; INDIVIDUAL 7.73 ± 1.27% and 7.60 ± 1.08%, P = .281) (time*visit effect P = .232, two-way repeated measures analysis of variance [ANOVA]). Body weight remained unchanged in the GROUP cohort (73.2 ± 14.0 vs 73.8 ± 14.8 kg, P = .361), while it increased in the INDIVIDUAL cohort (70.3 ± 13.5 vs 73.0 ± 13.7 kg, P < 0.001) (time*visit effect P = .009).

CONCLUSIONS

Group care is feasible in adult patients with type 1 diabetes using new technologies. Group visits can be beneficial in inducing lifestyle changes, as indicated by the favorable effects observed on body weight trend.

Peer Mentoring as an Avenue to Explore in Kidney Transplantation: Kidney Transplant Recipients' Perspectives on Peer Mentoring

Kidney transplant recipients (KTRs) face numerous challenges following transplantation. Given that healthcare professionals do not necessarily have first-hand experience living with or waiting for a transplant, it may be hard for them to communicate with and help patients when it comes to transplant-related issues. KTRs have experiential knowledge, which could enable them to help other patients going through similar situations. Peer mentoring involves pairing mentees with individuals who have had similar experiences, to provide training, information, and emotional support. The aim of this study was to gather KTRs’ perspectives on a potential peer mentoring program.