Healthy Changes Diabetes SelfManagement Program

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Sponsored by The National Council on the Aging
and CareSource
Healthy Aging Briefing Series
Healthy Changes Diabetes Self-Management Program
WELCOME
This session will begin promptly at 130pm
ESTPlease mute your phonePersonal
introductions are not necessaryThe moderator
will be on the line shortly
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Session Overview

• The presentation will discuss the benefits of
  offering a peer lead education and support group
  for individuals with diabetes.
• The presentation will focus on
• 1. How the Healthy Changes program can be
  implemented in a community based program with
  minimal cost
• 2. The advantages of using a tested, evidence
  based program
• 3. How the program can attract new participants
  to your site and provide a new opportunity for
  volunteers
• 4. Review of the experience of diverse
  communities using the program

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Epidemiology of the Problem

• One in five adults over age 60 has diabetes
• The occurrence of diabetes is 2 to 4 times
  greater in Native American, African American, and
  Latino communities.
• American Diabetes Association reports the cost of
  132 billion annually, or 1 in 10 healthcare
  dollars.
• Type 2 Diabetes accounts for 90 to 95 of all
  diagnosed cases of diabetes and most often occurs
  in people older than 40.
• Research studies have found that lifestyle
  changes can prevent or delay the onset of Type 2
  Diabetes among high-risk adults. Lifestyle
  changes include diet and moderate-intensity
  physical activity (such as brisk walking 30
  minutes on most days).

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Evidence-based Work on Diabetes Self Management

• Successful programs included both diabetes
  information and behavior change processes
• Healthful eating, glycemic control and
  increased physical activity.
• Self Care programs for older adults need
• Information
• Motivation Support
• Community Resources

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The Healthy Changes Model

• Based on Behavior Changes Theories the Healthy
  Changes model includes
• helping to specify target behaviors,
• setting goals,
• identifying barriers,
• selecting strategies,
• and providing support.

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Program Overview

• Target population
• Adults, 55 years old,
• Diagnosed with diabetes (most type 2)
• Either insulin dependent or non-insulin dependent
• Living independently and Cognitively intact
• Intervention dosage
• Community-based education and support groups
• Information focus physical activity nutrition
• Group led by a peer leader
• Weekly sessions of 1.5 hours, on-going, 26
  scripted sessions
• Individuals can join, drop and rejoin based on
  need
• Process for goal setting, problem solving, and
  peer support Road Map for Change

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Implementation

• Establishing a need
• Diabetes is an issue for population
• Meets organizational goals
• Getting leadership buy-in
• Advantage of evidence based program
• Agency capabilities
• Evaluation of readiness
• Resources (staff, facilities, materials)
• Identifying key partnerships
• Willingness to implement program as intended

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Implementation contd

• Recruitment of participants
• ONGOING
• Need multiple strategies
• Recruitment of peer leaders
• Critical to success of program
• May be opportunity to use volunteers in a new way

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Group Leader Selection

• Successful Group Leader Characteristics
• Experience leading groups helpful not necessary
• Understanding of diabetes
• Seen as a peer of the group they are leading
• Non-professional
• Personable
• Willing to present the program as developed
• Does not advocate for own beliefs
• Invested in success of program

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Recruitment Challenges

• Higher level of requirements than typical
  volunteers
• Often chose someone who was interested
• Approach program as a professional
• Interested in the education part only
• Thought the curriculum was nice reference
  material
• Did not relate well to other group members
• Needed the support from the group for their own
  issues (monopolized conversation)

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Defining the Role

• Establish a job description
• Conduct an interview
• Define Benefits
• Clearly define expectations
• Following program
• Length of commitment

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Training for the Role

• Basic understanding of diabetes (understanding
  limits)
• Understand diabetes self-management
• Understand behavior change principles
• Understand Healthy Changes program structure
• Understand empowerment approach
• Learn and practice facilitation skills
• Understand community resources

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Fidelity to Model

• Job interview
• Training
• On-going peer support and training
• Individual coaching
• Feedback sessions

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Healthy Changes Leaders

• 31 group leaders trained for 10 sites over three
  years
• Three leaders never led groups
• Two group leaders needed extra coaching and
  support
• Most sites have group leaders work in teams of 2
• One site never began
• On average leaders worked with program for one
  year

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What the Leaders Said

• Became more skilled at facilitating group
• Stressed over whether people will come, difficult
  people, hurt feelings and other peoples
  circumstances
• Felt good helping other people, learned a lot
  from others
• Stayed motivated

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Overview of Evaluation Design

• Primary outcome increased ability for older
  persons with diabetes to self-manage the diet and
  physical aspects of their diabetes.
• Secondary outcomes
• Diversity of population reached,
• Rates of attendance, reasons for attrition,
• Improvement in self-efficacy and problem-solving
  skills,
• Increased use of community resources,
• Increased sense of empowerment in communicating
  with health care providers.

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Preliminary Results
Demographic Profile

• 6 month pilot
• Age 65.7 (13.4)
• Gender 81 female
• SES (highest percentage)
• Income lt 10,000
• Educ. lt 12th grade

• 3 year study
• Age 68.0 (10.6)
• Gender 76 Female
• SES (Highest percentage)
• Income gt 20,000
• Educ. lt 12th grade

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Preliminary Results
Demographic Profile

• 6 month pilot
• Ethnicity
• Caucasian 76
• Latino 19
• American Indian or Alaska Native 3
• Other 3

• 3 year study
• Ethnicity
• Caucasian 59.9
• Latino 27.5
• American Indian or Alaska Native 9.3
• Other 3.3

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Preliminary Results

Post
Pre
Post
Pre
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Lessons Learned

• Program works well across diverse community
  groups.
• Community agencies serving older adults are not
  all appropriate to implement program.
• Review key components of project with site
  Leadership 2-3 times per year.
• Generational difference occurs between teacher
  vs. facilitator experience/skill.
• Peer group leaders need to be screened prior to
  training and observed after training.

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Lessons Learned contd

• Goal setting process can be too complicated for
  some group leaders to use consistently.
• Use of alternative methods (i.e.. an interactive
  CD-ROM) for teaching the basics may be more
  engaging for the participants.
• An addition to the curriculum, How to
  Communicate With Your Health Care Provider was
  added at request of participants.
• Leaders who are passionate advocates for a
  cause/issue become impediment to program.

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Lessons Learned contd

• Ongoing format of program is helpful for new
  participants to join group but challenging for
  agencies.
• Ongoing format difficult for monitoring data
  collection.
• Pilot test non-English versions of measures.
• Data collection would be much improved by using
  professionally-trained assessors.

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QUESTIONS?
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Dont Forget Your Free Copy of Aging in Stride
NCOA and Caresource are pleased to offer
first-time registrants for this Healthy Aging
Briefing Series a complimentary copy of the book,
Aging in Stride. To receive your copy, please
visit www.AgingInStride.org/NCOAoffer. Or just
email service_at_caresource.com with your name,
title, organization, mailing address, phone
number, and date of the Briefing you participated
in. One free copy per registrant, please.