Encouragement for Diabetes Self-Management
It was only by accident that JoAnn Thomas joined the patient advisory council for The Management of Diabetes in Everyday Life (MODEL) program, a PCORI-funded study of how to improve diabetes management. Her neighbor was a member but couldn’t attend the first meeting so she asked Thomas to go instead. Forced by her diabetes to retire from her career in customer service in 2007, Thomas, who is now 66, became an active council member, enthusiastic about reaching out to other people with diabetes.
The MODEL program is looking for more patients like Thomas. It’s reaching out to African Americans aged 18 and older who have uncontrolled diabetes. Study participants also must have at least one other chronic condition, usually high blood pressure, and live in medically underserved areas of the Mid-South.
Thomas is, in fact, a role model for the project. In 2007, her blood sugar level was at the top of the chart. Through lifestyle changes and adherence to her medication, it is now within the normal range.
“Taking care of yourself is difficult when you have diabetes,” says Jim Bailey, MD, MPH, of the University of Tennessee Health Sciences Center, who directs the project along with Jay Robinson, PsyD, CEO of Methodist South Hospital in Memphis. The project aims to determine the most effective approach, in areas with few doctors, for helping African Americans with uncontrolled diabetes make better decisions about eating properly, exercising, and taking their medication as directed.
This is especially important in the Mid-South, where more than 80 percent of people with diabetes have at least one other chronic condition, Bailey says. People with such serious health issues need regular medical care. But in a survey conducted by the study team, almost 20 percent of this population reported not having a primary care physician, which can lead to delays in getting needed care. More than half of those surveyed said they had never been encouraged to go to classes to learn how to manage their condition.
Finding a Strategy
The study team’s challenge was to find what would work best for this population to encourage self-care. “Our initial research found that 95 percent of these patients have cell phones, and 55 percent have smartphones,” says Bailey.
“With our patient advisory council, we discussed text messaging versus sitting down with a health coach,” recalls Thomas. “After debating both approaches, we reached a consensus and decided to test both ideas.” In addition to input from the patient advisory council, the team used data from surveys and focus groups in developing its randomized CER trial.
The focus groups helped design text messages that resonated with the participants. “Some are medication reminders, and others provide educational information. Still others are motivational,” explains Bailey. “We based the messages on patient-identified health goals, needs, and barriers to change.” Each month, the participants in the text message group are asked if they would like to modify the messages they have been receiving.
Similarly, participants in the health-coaching group meet in person or talk on the phone with their coach 14 or 15 times over a year. Depending on patients’ needs, the health coaching sessions emphasize patient navigation of the health system, bridging cultural gaps, and improving diet, exercise, and medication adherence.
The third group of participants will receive educational materials on diabetes tailored for patients who don’t read well. The team is basing the materials on the National Diabetes Prevention Program of the Centers for Disease Control and Prevention.
Getting to Results
The team is surveying the participants periodically for a year to assess whether there have been changes in key measures, including blood sugar, blood pressure, and weight.
The project is currently recruiting participants and encouraging physicians at the participating clinics to spread the word. The first results should be available in about a year.
“We’ll have to wait and see which approach is most effective,” Robinson says. “I think it will come down to personal preference.” That preference may depend on access to doctors. One possibility, Robinson says, is that people in rural areas may prefer text messaging.
Inadvertently, the program may have found another way to contact possible participants—by encouraging members on the patient advisory council to reach out to their peers.
“When I met a gentleman on the council who had lost his sight because of diabetes, it was another wake-up call for me,” Thomas says. “Now, I spread the word to friends and neighbors who have the disease. We are a powerful voice in relating to patients and helping them understand why they need to follow the rules and do what they can to take care of themselves.”