Seminar: Implementation & Evaluation of a Cognitive Behavioral Therapy Based Diabetes Self-Management Program Delivered by Peer Coaches

Presented by: Susan Andreae, PhD

Postdoctoral Fellow, Division of Preventive Medicine

School of Medicine, University of Alabama at Birmingham

Abstract:

As many as 75% of people with diabetes report chronic pain. While cognitive behavioral therapy (CBT) improves pain and functioning in individuals with chronic pain, many rural and underserved communities lack the resources to provide such programs. We tested the hypothesis that a CBT-based program delivered by community peer coaches can improve functional status, quality of life, and health outcomes in individuals with diabetes and chronic pain. The Living Healthy study was a community-based, clustered randomized controlled trial. Intervention participants received a telephone-administered, diabetes self-management program delivered by a trained peer coach. Attention control participants received general health advice with an equal number of peer coach contacts. Primary outcomes at 3 months were functional status, quality of life, hemoglobin A1c, systolic blood pressure (SBP), and body mass index (BMI). Of the 195 participants with follow-up data, 80% were women, 96% African American, 74% had incomes less than $20,000 per year, and 64% had a high school education or less. Compared to control participants at follow-up, intervention participants had greater improvement in functional status and pain. Intervention participants also had greater improvement in health-related quality of life. Physiologic measures (HbA1c, SBP, and BMI) were similar in both study arms. This CBT-based intervention delivered by trained peer coaches improved functioning, pain, and quality of life in individuals with diabetes and chronic pain. This study illustrates the potential to use community members to deliver structured CBT-based interventions to improve health outcomes in rural and under-resourced communities.