Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Center for Clinical Management Research, Ann Arbor Veterans' Affairs (VA) Healthcare System, Ann Arbor, Michigan.
Ann Fam Med. 2021 Nov-Dec;19(6):532-539. doi: 10.1370/afm.2742.
We undertook a study to ascertain patient characteristics associated with enrollment and engagement in a type 2 diabetes peer health coaching program at an urban health care facility serving predominantly Black veteran men, to improve the targeting of such programs.
A total of 149 patients declined enrollment in a randomized controlled trial but provided sociodemographic, clinical, and psychosocial information. A total of 290 patients enrolled and were randomized to 2 peer coaching programs; they provided sociodemographic, clinical, and survey data, and were analyzed according to their level of program engagement (167 engaged, 123 did not engage) irrespective of randomization group. Qualitative interviews were conducted with 14 engaged participants.
Patients who enrolled were more likely to be Black men, have higher levels of education, have higher baseline hemoglobin A levels, describe their diabetes self-management as "fair" or "poor," and agree they "find it easy to get close to others" ( <.05 for each). At the program's end, patients who had engaged were more likely than those who had not to describe their peer coaches as being supportive of their autonomy (mean score, 85.4 vs 70.7; <.001). The importance of coaches being encouraging, supportive, and having common ground/shared experiences with participants also emerged as key themes in interviews with engaged participants.
Individuals with greatest perceived need were more likely to enroll in our trial of peer coaching, but the only factor associated with engagement was finding one's coach to support autonomy. Our findings reinforce the importance of training and ensuring fidelity of peer coaches to autonomy-supportive communication styles for participant engagement. In tailoring peer support programs for Black men, future research should elucidate which shared characteristics between participant and peer coach are most important for engagement and improved outcomes..
我们进行了一项研究，旨在确定与在一家主要为黑人退伍军人男性服务的城市医疗保健机构中参与 2 型糖尿病同伴健康辅导计划相关的患者特征，以改善此类计划的针对性。
共有 149 名患者拒绝参加一项随机对照试验，但提供了社会人口统计学、临床和心理社会信息。共有 290 名患者入组并随机分为 2 个同伴辅导项目；他们提供了社会人口统计学、临床和调查数据，并根据他们的项目参与水平（167 名参与，123 名不参与）进行分析，而不论随机分组如何。对 14 名参与的参与者进行了定性访谈。
入组的患者更可能是黑人男性，受教育程度更高，基线血红蛋白 A 水平更高，描述自己的糖尿病自我管理为“一般”或“差”，并表示他们“发现与他人亲近很容易”（每项<.05）。在项目结束时，与未参与的患者相比，参与的患者更有可能描述他们的同伴教练支持他们的自主权（平均得分，85.4 与 70.7；<.001）。在与参与的参与者的访谈中，还出现了教练鼓励、支持和与参与者有共同基础/共同经历的重要性这一主题。
自我评估需求最大的个体更有可能参加我们的同伴辅导试验，但唯一与参与相关的因素是找到支持自主的教练。我们的研究结果强调了培训和确保同伴教练对自主支持性沟通风格的保真度对于参与者参与的重要性。在为黑人男性量身定制同伴支持计划时，未来的研究应该阐明参与者和同伴教练之间最重要的共同特征是什么，以实现参与和改善结果。
