The development, implementation, and evaluation of a peer leader training program

Transcription

1 The development, implementation, and evaluation of a peer leader training program Tricia S. Tang, PhD Associate Professor University of British Columbia School of Medicine December 6, 2011

2 Diabetes Self-Care Continuum Diabetes Self- Management Education (DSME) Diabetes Self- Management Support (DSMS)

3 Short-term gains Portion control Long-term

4 DSME models: Limitations Time-limited Curriculum-driven Resource-intensive

5 Time-limited May NOT exceed 10 hours one-time benefit for beneficiaries MD must document the specific medical need for follow-up training. Follow-up training cannot exceed 2 hours per year.

6 Curriculum-driven Sorry, I can t answer that until we get to Lesson Plan 8 Longterm complications. Can diabetes make you go blind? During Lesson 1 Healthy Eating, Homer asks a reasonable question.

7 Resource-Intensive One CDE 1,445 patients

8 Diabetes Self-Care Continuum Diabetes Self- Management Education (DSME) Diabetes Self- Management Support (DSMS) Time-limited curriculum-led Resource-intensive Ongoing Patient-led Low to no-cost

9 Potential role for peer support

10 Peer Support Peer support is the provision of emotional, appraisal, and informational assistance by a created social network member who possesses experiential knowledge of a specific behavior or stressor and similar characteristics as the target population Peer Leader - term for person who provides peer support

11 Diabetes Self-Care Continuum Diabetes Self- Management Education (DSME) Diabetes Self- Management Support (DSMS) Certified Diabetes Educator (CDE) Deliver diabetes education Build motivation for change Teach skills for behavior change Provide support Peer Leader (PL) Maintain motivation Sustain behavioral changes Provide ongoing support

12 Can we train peer leaders?

13 Study Aims Aim 1: To determine the feasibility of developing a program training peer leaders (PLs) to facilitate empowerment-based interventions that support long-term diabetes self-management Aim 2:To determine the feasibility of conducting a peer leader training (PLT) program to facilitate empowerment-based interventions. Aim 3: To determine the feasibility of graduating 4 PLs who fulfill the pre-established competency criteria.

14 Study Aims Aim 1: To determine the feasibility of developing a program training peer leaders (PLs) to facilitate empowerment-based interventions that support long-term diabetes self-management Aim 2:To determine the feasibility of conducting a peer leader training (PLT) program to facilitate empowerment-based interventions. Aim 3: To determine the feasibility of graduating 4 PLs who fulfill the pre-established competency criteria.

15 Study Aims Aim 1: To determine the feasibility of developing a program training peer leaders (PLs) to facilitate empowerment-based interventions that support long-term diabetes self-management Aim 2:To determine the feasibility of conducting a Peer Leader Training (PLT) program to facilitate empowerment-based interventions. Aim 3: To determine the feasibility of graduating 4 Peer Leaders who fulfill the pre-established competency criteria.

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18 Program Components Knowledge acquisition ADA s nine core diabetes education topics Skills development Empowerment-based facilitation Active listening 5-step behavioral goal-setting process Making an action plan Experiential learning Facilitation simulations Playing the role of peer leaders

19 Diabetesrelated knowledge Active listening skills Selfefficacy Empowermentbased facilitation

20 Diabetes-related knowledge Diabetes knowledge test (DKT) 80% correct Diabetes knowledge questionnaire (DKQ) 80% correct Understanding Management Practice (UMP) Mean score of 4 of 5-point Likert scale

21 Active Listening Observation Scale (ALOS)

22 Empowerment Rating Form +2 points = Exploring problem and feelings +1 points = Focusing on goal 0 points = miscellaneous -1 points = Giving advice -2 points = Judging the person Trainees must score a +2 on 3 of 6 vignettes and at least a +1 on the other 3 vignettes.

23 Self-Efficacy Core Skills

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25 Recruitment Approaches Contact graduates of previous professionally-led DSMS programs Referrals from physicians and community leaders

26 Have diabetes Be a resident of the greater Ypsilanti, MI community Be 40 years old Eligibility Screening Have transportation to attend training Be willing to commit 3-4 months for training

27 Eligibility Interview Individual interview Group Interview

28 (1) Individual interview Questions What are your thoughts about the peer support program? Why do you think you would make a good peer leader What has been most helpful to you in taking care of your diabetes? Problem resolution respond to the following situation

29 (2) Group interview Group role-play Group facilitator Person with problem Group participants Example scenario: My kids are always on me about my diabetes. They think they know more about it than I do.

30 Peer Leaders (n=8) Mean age = 63 years Mean years since dx = 14.3 (SD=5) 75% women; 25% men 75% college degree or higher

31 peer support intervention Results Recruited 9 trainees (1 dropout) Mean attendance rate 100% Retained 8 peer leaders 75% Diabetes-related knowledge 75% Empowerment-based facilitation 63% Active listening 75% Self-efficacy 100% future intentions to facilitate

32 Program Satisfaction Items Strongly Disagree Disagree Neutral Agree Strongly Agree Mean (SD) 1. The length of the training program was just right (0.75) 2. The length of the training sessions was just right (0.52) 3. The balance between diabetes education content & skills development was just right (0.75) 4. I feel prepared to co-facilitate a support group (0.70) 5. I feel prepared to work one -onone with participants (0.53)

33 Program Efficacy Teaching Activities Not effective Somewhat effective Moderately effective Very effective Extremely effective Mean (SD) 1. Quizzes (0.53) 2. Lecturettes (0.74) 3. Peer leader simulations (0.64) 4. Group brainstorming (0.46) 5. Group sharing (0.46) 6. Role-plays (1.12) 7. Group facilitation simulations (0.92) 8. Reading assignments (052)

34 Discussion Feasibility of the Peer Leader Training Factors contributing to success Recruited well-known trainees Recruited retirees Program evaluation Dissemination and replication

35 Future Directions

36 Research Team Martha Funnell, RN, CDE Michele Heisler, MD, MPA Bob Anderson, Ed.D Robin Nwankwo, MA, CDE Marylou Gillard, RN, CDE