Search

Abstract: We are conducting a community-based cluster-randomized trial in rural Alabama, testing a peer-support intervention designed to improve diabetes self-care behaviors. We describe recruitment and data collection approaches used, focusing on strategies that created community partnerships and facilitated recruitment in underserved, rural, largely minority communities. Key recruitment and data collection strategies included early community engagement; pilot testing of procedures; inclusion of community members as study team members, recruiters, and data collectors; data collection at community venues to minimize participant travel requirements; and provision of a multi-disciplinary diabetes education program to both intervention and control participants. A total of 424 participants were recruited and enrolled (400 targeted). Of the 759 referrals received, 78.9% (n =599) successfully completed telephone screening. Of these, 78.8% (n =472) were eligible and scheduled for a local enrollment day, and 81.4% (n =384) attended and enrolled in the study. In addition, community members who walked in and expressed interest were screened, and 40 eligible and willing individuals were consented and enrolled. We exceeded recruitment goals in underserved, rural communities in Alabama. This success was due in large part to community partnerships that facilitated community involvement on several levels: engaging the community early in study proposal and design; hiring community members to fill various capacities as research team members, recruiters, and data collectors; conducting data collection within communities; and collecting additional contact information to maintain communication. Providing diabetes education to all participants, including intervention and control, helped ensure that everyone stood to benefit and likely enhanced overall participation. [Copyright &y& Elsevier]

Because medication adherence is linked to better diabetes outcomes, numerous interventions have aimed to improve adherence. However, suboptimal adherence persists and necessitate continued research into intervention strategies. This study evaluated the effectiveness of an intervention that combined storytelling and peer support to improve medication adherence and health outcomes in adults with diabetes. Living Well with Diabetes was a cluster randomized controlled trial. Intervention participants received a six-month, 11-session peer-delivered behavioral diabetes self-care program over the phone. Control participants received a self-paced general health program. Outcomes were changes in medication adherence and physiologic measures (hemoglobin A1c, systolic blood pressure, low-density lipoprotein cholesterol, body mass index). Of the 403 participants with follow-up data, mean age was 57 (±SD 11), 78% were female, 91% were African American, 56.4% had high school education or less, and 70% had an annual income of < $20,000. At follow-up, compared to controls, intervention participants had greater improvement in medication adherence (β = −0.25 [95% CI -0.35, −0.15]). Physiologic measures did not change significantly in either group. Intervention participants had significant improvements in beliefs about the necessity of medications (β = 0.87 [95% CI 0.27, 1.47]) concerns about the negative effects of medication (β = −0.91 [95% CI -1.35, −0.47]), and beliefs that medications are harmful (β = −0.50 [95% CI -0.89, −0.10]). In addition, medication use self-efficacy significantly improved in intervention participants (β = 1.0 [95% CI 0.23, 1.76]). 473 individuals were enrolled in the study and randomized. Living Well intervention resulted in improved medication adherence, medication beliefs, and medication use self-efficacy but not improved risk factor levels. [ABSTRACT FROM AUTHOR]