Peer coach delivered storytelling program improved diabetes medication adherence: A cluster randomized trial

Susan J Andreae; Lynn J Andreae; Andrea L Cherrington; Joshua S Richman; Ethel Johnson; Debra Clark; Monika M Safford

doi:10.1016/j.cct.2021.106358

Peer coach delivered storytelling program improved diabetes medication adherence: A cluster randomized trial

Contemp Clin Trials. 2021 May:104:106358. doi: 10.1016/j.cct.2021.106358. Epub 2021 Mar 15.

Authors

Susan J Andreae¹, Lynn J Andreae², Andrea L Cherrington³, Joshua S Richman⁴, Ethel Johnson⁵, Debra Clark⁶, Monika M Safford⁷

Affiliations

¹ Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States of America. Electronic address: sandreae@wisc.edu.
² Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America. Electronic address: landreae@uabmc.edu.
³ Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America. Electronic address: acherrington@uabmc.edu.
⁴ Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America. Electronic address: jrichman@uabmc.edu.
⁵ Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America. Electronic address: ethelj@uab.edu.
⁶ Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America. Electronic address: debrasclark@uabmc.edu.
⁷ Department of Medicine, Weill Medical College of Cornell University, New York, NY, United States of America.

PMID: 33737200
DOI: 10.1016/j.cct.2021.106358

Abstract

Background: 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.

Methods: 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).

Results: 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.

Discussion: Living Well intervention resulted in improved medication adherence, medication beliefs, and medication use self-efficacy but not improved risk factor levels.

Keywords: Community health workers; Community peer coaches; Diabetes; Medication adherence.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Blood Pressure
Diabetes Mellitus* / drug therapy
Diabetes Mellitus, Type 2*
Female
Glycated Hemoglobin / analysis
Humans
Medication Adherence
Middle Aged
Self Care

Substances

Glycated Hemoglobin A