JMIR Publications

ABSTRACT

Background:

Patients with diabetes experience worse health outcomes and greater healthcare expenditure. Improving diabetes outcomes requires involved self-management. Peer support programs are one way patients can engage in self-management while addressing individual and structural barriers. These peer coaching programs can be scaled to digital platforms to efficiently connect patients with supporters who can help with diabetes self-management.

Objective:

The purpose of the current study is to evaluate the implementation of a technology-enabled peer coaching intervention to support diabetes self-management among patients with uncontrolled diabetes.

Methods:

MetroPlusHealth, a predominant Medicaid HMO based in New York City, partnered with InquisitHealth to enroll 300 Medicaid patients with uncontrolled diabetes into its 6-month peer mentoring intervention. InquisitHealth peer mentors conduct at least 2 evidence-based and goal-oriented coaching sessions per month with their assigned patients. These sessions are focused on addressing both behavioral and social determinants of health with the goal of helping patients increase their diabetes self-management literacy, implement self-management behaviors, and reduce barriers to ongoing self-care. Data analyzed in this study included patient demographic data, clinical data (patient’s A1C), and program implementation data including types of behavioral determinants of health (BDoH) and social determinants of health (SDoH) reported by patients and types of interventions used by peer coaches.

Results:

A total of 330 patients enrolled in the peer mentoring program and 2118 patients were considered to be on a waitlist group and used as a comparator. Patients who enrolled in the peer mentoring program were older, more likely to be English speakers, female, and African American, but less likely to be white or Asian American/Pacific Islander than those in the waitlist condition, and had similar A1C lab results at baseline (intervention group 10.59 vs. waitlist condition 10.62) Patients in the enrolled group had on average a -1.37 point reduction in A1C score (n = 70; pre = 10.99; post = 9.62; P < .001) whereas patients in the waitlist group had a -0.16 reduction in A1C score (n = 207; pre = 9.75; post = 9.49; P < .001). Among a subsample of participants enrolled in the program with at least two A1C scores we found that endorsement of emotional health issues (B = 1.344, p = .04) and medication issues (B = 1.36, p = .04) were significantly related to increases in A1C.

Conclusions:

This analysis of a digital, remotely-delivered 1-on-1 peer coaching program shows promise in improving diabetes self-management in a typically marginalized population with significant SDoH barriers. Program participants showed improved A1C levels and analyses found that people with emotional stressors and medication management issues had worse outcomes and that many preferred to connect via phone calls vs. an app. Altogether, these findings support the effectiveness of digital programs with multimodal approaches that include human support can be successful when they engage with empathy and address real world issues including digital literacy, as well as both behavioral and social determinants of health.