Ongoing Diabetes Self-Management Support in Church-Based Settings
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Diabetes, Diabetes |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 21 - Any |
| Updated: | 12/19/2018 |
| Start Date: | January 2013 |
| End Date: | December 31, 2019 |
African Americans are twice as likely to have diabetes compared to their White counterparts
and experience higher rates of diabetes-related complications. Diabetes-related health
disparities underscore the need for effective, culturally tailored approaches to promote and
sustain diabetes self-management over time. Diabetes self-management education (DSME) is
effective in improving diabetes outcomes in the short-term. However, many adults with
diabetes cannot sustain achieved improvements without continued follow-up and support. The
2012 revisions of both the National Standards for Diabetes Care 6 and the National Standards
for DSME and Support emphasize the importance of providing both initial DSME and on-going
diabetes self-management support (DSMS) to assist people with diabetes in maintaining
effective self-management throughout a lifetime. While a great deal is understood about how
to provide effective, initial DSME, less is known about who, where, when, and how to provide
effective, sustained DSMS. One significant challenge is that DSME is a covered benefit in the
healthcare system, while DSMS is not. This ultimately limits access and availability of DSMS
programs, especially for low-income African Americans. Accordingly, there is critical need to
develop, evaluate, and understand effective DSMS models that are ongoing, patient-driven, and
embedded in the community.
and experience higher rates of diabetes-related complications. Diabetes-related health
disparities underscore the need for effective, culturally tailored approaches to promote and
sustain diabetes self-management over time. Diabetes self-management education (DSME) is
effective in improving diabetes outcomes in the short-term. However, many adults with
diabetes cannot sustain achieved improvements without continued follow-up and support. The
2012 revisions of both the National Standards for Diabetes Care 6 and the National Standards
for DSME and Support emphasize the importance of providing both initial DSME and on-going
diabetes self-management support (DSMS) to assist people with diabetes in maintaining
effective self-management throughout a lifetime. While a great deal is understood about how
to provide effective, initial DSME, less is known about who, where, when, and how to provide
effective, sustained DSMS. One significant challenge is that DSME is a covered benefit in the
healthcare system, while DSMS is not. This ultimately limits access and availability of DSMS
programs, especially for low-income African Americans. Accordingly, there is critical need to
develop, evaluate, and understand effective DSMS models that are ongoing, patient-driven, and
embedded in the community.
The long-term goal of our research is to determine the most effective, practical, and
sustainable approaches to provide ongoing DSMS in the context of the communities in which
people live. In the African American community, the church plays a central role in community
life and can serve as a powerful channel to deliver health promotion programs. Churches in
the community are thus ideal venues to intervene to help people with diabetes achieve their
self-management related goals. The objective of this proposal is to examine the relative
effectiveness of three approaches to address DSMS compared to enhanced usual care within the
context of the church-based setting. To accomplish this objective, a cluster randomized,
modified stepped wedge, practical behavioral trial with three parallel DSMS approaches will
be implemented. Twenty-one African American churches (23 African American participants per
church) in metro-Detroit will be randomized to one of three DSMS approaches. Fourteen parish
nurses who are volunteers at the churches, and 21 peer leaders will be trained to deliver
DSMS. Measures will be collected at baseline, 6, 9, 15 and 27-month follow-up. The primary
outcome will be changes in A1c at 9, 15 and 27-month follow-up. Secondary outcomes include
changes in weight, blood pressure, quality of life, and diabetes related distress at 9,15 and
27-month follow-up. We hypothesize that 1) participants in both Parish Nurse DSMS and Peer
Leader DSMS will have improved outcomes over enhanced usual care, and that 2) participants in
Parish Nurse + Peer Leader DSMS will sustain improvements in outcomes achieved following DSME
at significantly higher levels than participants in Parish Nurse DSMS and Peer Leader DSMS
sustainable approaches to provide ongoing DSMS in the context of the communities in which
people live. In the African American community, the church plays a central role in community
life and can serve as a powerful channel to deliver health promotion programs. Churches in
the community are thus ideal venues to intervene to help people with diabetes achieve their
self-management related goals. The objective of this proposal is to examine the relative
effectiveness of three approaches to address DSMS compared to enhanced usual care within the
context of the church-based setting. To accomplish this objective, a cluster randomized,
modified stepped wedge, practical behavioral trial with three parallel DSMS approaches will
be implemented. Twenty-one African American churches (23 African American participants per
church) in metro-Detroit will be randomized to one of three DSMS approaches. Fourteen parish
nurses who are volunteers at the churches, and 21 peer leaders will be trained to deliver
DSMS. Measures will be collected at baseline, 6, 9, 15 and 27-month follow-up. The primary
outcome will be changes in A1c at 9, 15 and 27-month follow-up. Secondary outcomes include
changes in weight, blood pressure, quality of life, and diabetes related distress at 9,15 and
27-month follow-up. We hypothesize that 1) participants in both Parish Nurse DSMS and Peer
Leader DSMS will have improved outcomes over enhanced usual care, and that 2) participants in
Parish Nurse + Peer Leader DSMS will sustain improvements in outcomes achieved following DSME
at significantly higher levels than participants in Parish Nurse DSMS and Peer Leader DSMS
Inclusion Criteria for Parish Nurses
- Registered nurse in Michigan
- Identified as a parish nurse in the participating church
- Member of the Detroit Parish Nurse Network
- Willing to serve as a parish nurse for the research study
Inclusion Criteria for Peer Leaders
- Have diabetes ≥ one year
- Be a resident of metro-Detroit
-≥21 years old and ≥ 8th grade education
- Have transportation to attend training
- Be willing to commit to 3 months of training
- Actively working on his/her own self management goals and
- Willing to serve as a peer leader
Inclusion Criteria for Participants
- Have diabetes ≥ 6 months
- Resident of metro-Detroit
-≥ 21years old
- Be under the care of a physician for diabetes
- Have transportation to attend the program
- Be a member or regularly attend the participating church
Exclusion Criteria for Parish Nurses
- Not a registered nurse
- Not a parish nurse in the church
- Not a member of the DPNN
- Unwilling to serve as a parish nurse for the research studyExclusion Criteria for
Participants:
- Non ambulatory or serious health conditions or psychiatric illness (severity requiring
hospitalization)
- Serious diabetes complications (e.g. blindness) that would impede meaningful
participation
Exclusion Criteria for Peer Leaders and Participants:
- Non ambulatory or serious health conditions or psychiatric illness (severity requiring
hospitalization)
- Serious diabetes complications (e.g. blindness) that would impede meaningful
participation
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