The impact of diabetes education and peer support upon weight and glycemic control of elderly persons with noninsulin dependent diabetes mellitus (NIDDM).
ABSTRACT We assessed diabetes education and peer support interventions as facilitators of weight loss and glycemic control in a community sample of 79 elderly persons with noninsulin-dependent diabetes mellitus (NIDDM). Different groups received: education only, education and peer support, and no treatment. Peer support was higher in groups where it was actively facilitated. Weight loss and reduction in level of glycemic control occurred within groups receiving both diabetes education and peer support.
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ABSTRACT: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate the volunteer telephone smoking cessation counseling follow-up program implemented as part of the inpatient Tobacco Tactics intervention in a Veterans Affairs (VA) hospital. This was a quasi-experimental, mixed methods design that collected data through electronic medical records (EMR), observations of telephone smoking cessation counseling calls, interviews with staff and Veterans involved in the program, and intervention costs. Reach: Of the 131 Veterans referred to the smoking cessation telephone follow-up program, 19% were reached 0-1 times, while 81% were reached 2-4 times. Effectiveness: Seven-day point-prevalence 60-day quit rates (abstracted from the EMR) for those who were reached 2-4 times were 26%, compared to 8% among those who were reached 0-1 times (p = 0.06). Sixty-day 24-hour point-prevalence quit rates were 33% for those reached 2-4 times, compared to 4% of those reached 0-1 times (p < 0.01). Adoption and Implementation: The volunteers correctly followed protocol and were enthusiastic about performing the calls. Veterans who were interviewed reported positive comments about the calls. The cost to the hospital was $21 per participating Veteran, and the cost per quit was $92. Maintenance: There was short-term maintenance (about 1 year), but the program was not sustainable long term. Quit rates were higher among those Veterans that had greater participation in the calls. Joint Commission standards for inpatient smoking with follow-up calls are voluntary, but should these standards become mandatory, there may be more motivation for VA administration to institute a hospital-based, volunteer telephone smoking cessation follow-up program. ClinicalTrials.Gov NCT01359371.Tobacco Induced Diseases 12/2015; 13(1):4.
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ABSTRACT: Elder population is becoming proportionally a larger segment of the total population and among their health problems, diabetes mellitus (DM) is one of their main causes of death and disability. In DM, self-management is the basis for a better control, which is why public policy makers and healthcare providers should have available analytic tools that allow them to discriminate among the best self-care interventions in diabetes for older patients. Even though there are several meta-analyses already that offer this kind of review, this article proposes the use of Mechner's behavioral contingencies language to compare different approaches. Three interventions were described with this notation and even though there were some limitations for this analysis due to the fact that some results were not comparable or not available in the original papers, this formal symbolic language demonstrated to be useful for making analytical comparisons visually accessible, providing a better understanding of the contingencies that are at play in the situation and giving the advantage of cutting across all natural languages.Suma Psicológica. 01/2012; 19(1):33-44.
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ABSTRACT: This article overviews the scope and progression of research on behavioral aspects of diabetes over the past decade at the Oregon Research Institute. Our research team has investigated several topics including: (a) conceptual models of self-management; (b) social learning factors associated with regimen adherence; (c) individual and group-based interventions to enhance diabetes self-management; (d) rates and determinants of participation in diabetes education; (e) determinants of glycemic control; and (f) patient models (beliefs) about diabetes and its treatment.We have employed a social learning theory approach to diabetes management, and over the past decade have come to adopt a broader public health perspective that addresses environmental influences on diabetes self-management at multiple levels (e.g. family, health care system, community). This approach has led us to conclude that increased attention should be devoted to the most prevalent types of diabetes, to the behavioral issues that create the most difficulty for the greatest number of patients, and to the social environment in which patients live and diabetes management education takes place. Our research focus has evolved over time and currently emphasizes: (a) assessment and tailoring of intervention based upon the patient's perspective; (b) patient-provider interactions; and (c) brief, low-cost, and system-wide interventions that can be implemented in medical office settings. Lessons learned from this research, the potential disseminability of our findings, and future directions are summarized.Annals of Behavioral Medicine 03/1995; 17(1):32-40. · 4.20 Impact Factor
The Impact of Diabetes Education and Peer Support upon Weight and
Glycemic Control of Elderly Persons with Noninsulin Dependent
Diabetes Mellitus (NIDDM)
WILLETTA WILSON, PHD, AND CLARA PRATT, PHD
Abstract: We assessed diabetes education and peer support
interventions as facilitators of weight loss and glycemic control in a
community sample of 79 elderly persons with noninsulin-dependent
diabetes mellitus (NIDDM). Different groups received: education
only, education and peer support, and no treatment. Peer support
was higher in groups where it was actively facilitated. Weight loss
and reduction in level of glycemic control occurred within groups
receiving both diabetes education and peer support. (Am J Public
Health 1987; 77:634-635.)
Noninsulin-dependent diabetes mellitus (NIDDM) is the
most common type of diabetes.' The majority of individuals
with NIDDM are obese.2 Dietary modification, the treatment
of choice for obese persons with NIDDM,3 is rarely effec-
tive.7 The purposes of the current study were:
determine whether supportive behavior could be elicited
from elderly peers in a diabetes education class, and 2) to
determine the incremental effects upon weight loss and upon
the reduction in blood glucose levels when social support is
added to diabetes education.
Registration for the project was through senior citizen
centers or nutrition sites located in four largely rural counties
of Oregon. All participants had diabetes mellitus, were not
treated with insulin, and had been advised by their health care
provider to lose weight. Of the 79 subjects, 80 per cent were
female and 20 per cent male. The mean age was 68.2 (SD =
7.2) and initial mean assessments ofbody weight and level of
blood glucose were 165.7 lbs (SD = 36.2) and 57.9 nmoles per
fructose equivalent (SD = 14.1).
Three groups were formed: education only (E), (n = 19);
education and peer support (E+PS), (n = 32); and control
(C), (n = 28). All interventions and assessments were
conducted at the senior centers and nutrition sites through
which participants had registered. Because the sites were
located over a largely rural, four-county area, it was not
feasible to randomly assign participants to conditions, so
sites were randomized. There were three sites assigned to
Ten 60-minute education classes were conducted by a
registered dietitian. Basic concepts about diabetes and its
nutritional aspects served as the foundation for all sessions.
E groups received an additional hour of unstructured class
time at each meeting. Peer support sessions, also 60 minutes
Address reprint requests to Willetta Wilson, PhD, Research Scientist,
Oregon Research Institute, 1899 Willamette Street, Eugene, OR 97401. Dr.
Pratt is with Oregon State University. This paper, submitted to the Journal
April 24, 1986, was revised and acceptedforpublicationOctober 16, 1986.
© 1987 American Journal of Public Health 0090-0036/87$1.50
long, immediately followed for the E+PS groups. The peer
support facilitator was trained in group dynamics, and sought
to foster peer interaction, focusing on group behaviors
critical to self-help groups.8 For each intervention, eight
sessions were held weekly. The ninth and tenth sessions were
held during week 12 and week 16, respectively.
Glycosylated hemoglobin (GHb) was measured with a
colormetric assay procedure.9 Weight was measured with a
portable scale, calibrated with a standard weight. Level of
peer support was measured with an adaptation ofthe Arizona
Social Support Schedule.'0 Other psychosocial variables
were measured with an adaptation of the Diabetes Educa-
tional Profile." Assessments of all variables was made
preintervention, postintervention-1 (week 8), and postinter-
vention-2 (week 16).
There were no between-group differences in peer sup-
port, weight, or level of GHb at preintervention. At
postintervention-l mean peer support levels in group E+PS
(67.9, SD = 23.9) were higher than mean peer suport levels
reported for group E (50.8, SD = 24.9), (Xd = 17.1, 95%
CI:3.1, 31.1). Moderate weight loss and reduction of GHb
level occurred in group E+PS, but not in other groups at
postintervention-l (Table 1).
Our data indicate that peer support can be enhanced
among elderly persons attending diabetes education classes
and it is related to desired changes in health behavior. Group
E+PS experienced substantially greater weight loss and an
initial reduction in GHb level than group E.
The size ofour samples was small and the duration ofthe
interventions was less than optimal to show changes in level
of GHb. While GHb changes can be detected at eight-week
intervals,'2 a three-month interval may be better.'3"14 A one
year follow-up would have indicated whether the interven-
tions had a more lasting impact.
Nevertheless, community-dwelling persons with
NIDDM were studied, in contrast to the more typical and less
generalizable studies of young insulin-dependent diabetic
patients evaluated while they are hospitalized or at a diabetes
summer camp.15"16Moreover, group E+PS facilitated reduc-
tions in weight and GHb, at least on a short-term basis. This
finding warrants additional investigation ofpeer supportas an
adjunct to diabetes education and other types of patient
education. Including a group facilitator on the diabetes
education team might increase costs, but the increased
efficacy of diabetes education should compensate for the
expenditure. With diabetes' annual total economic impactof
at least $14 billion,'7 we should be able to afford investigating
procedures that might improve the prognosis for the 5.8
million individuals with diabetes.'8
A6JPH May 1987, Vol. 77, No. 5
PUBLIC HEALTH BRIEFS
TABLE 1-Difference Scores and Confidence Intervals for Preintervention, Postintervention-1, and
Postinterventlon-2 Scores within Groups [Education only (E), Education and Peer Support (E+PS),
and Control (C)]
Group E (N = 19)
-1.2 lbs. (-2.6, +0.2)
-0.5 lbs. (-1.8, +0.5)
Group E+PS (N = 32)
-3.1 nmoles (-7.7, +1.5)
+1.1 nmoles (-1.1, +3.2)
-5.5 lbs. (-6.8, -4.2)
+0.5 lbs. (-0.4, +1.4)
Group C (N = 28)
-3.7 nmoles (-5.7, -0.5)
+2.0 nmoles (+0.9, +3.0)
+0.6 lbs. (-1.1, +1.8)
-0.7 nmoles (-2.5, +11.1)
NOTE: Postintervention-2 data are not reported for group C.
anmoles per fructose equivalent.
This work was support by a grant from the Andrus Foundation.
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