scholarly journals A Feasibility Pilot Trial of a Peer-support Educational Behavioral Intervention to Improve Diabetes Medication Adherence in African Americans

2021 ◽  
Author(s):  
Olayinka Shiyanbola ◽  
Martha Maurer ◽  
Mattigan Mott ◽  
Luke Schwerer ◽  
Nassim Sarkarati ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
African Americans ◽  
Effect Size ◽  
Self Efficacy ◽  
Hemoglobin A1c ◽  
The United States ◽  
Post Intervention ◽  
Phone Calls

Abstract BackgroundAfrican Americans are twice as likely to die from diabetes, compared to other racial and ethnic groups in the United States. Poor adherence to diabetes medications is common among African Americans and contributes to these disproportionally worse outcomes. A pilot study was conducted to determine the feasibility and acceptability of a peer-supported intervention targeting diabetes and medication beliefs, communication, and self-efficacy skills to enhance medication adherence among African Americans with type 2 diabetes. MethodsBased on the extended self-regulatory model and information-motivation-behavioral skills model, this intervention was piloted using a single group pre/post-intervention study design at two sites. Seventeen African Americans who self-reported as adherent to diabetes medicines (ambassadors), were paired with 22 African Americans with self-reported poor medication adherence (buddies). Measures assessed at baseline and one-month post-intervention included glycemic control (hemoglobin A1c), self-reported medication adherence, diabetes beliefs, concerns about diabetes medicines, and diabetes self-efficacy. Wilcoxon signed rank tests assessed for differences in mean scores of outcome variables at baseline compared with 3-months follow-up. Semi-structured 60-minute interviews were conducted with each buddy to explore their acceptability of the intervention. To ensure the rigor of the qualitative data, we focused on analytic criteria such as credibility, confirmability, and transferability.ResultsMost buddies and ambassadors were female and about 56 years old. Feasibility outcomes included recruitment success rates of 73% for buddies and 85% for ambassadors relative to our goals. Retention rate for hemoglobin A1c and medication adherence outcome assessment was 95% for buddies. Both buddies and ambassadors had excellent intervention adherence, with buddies having a mean attendance of 7.76 out of 8 sessions/phone calls and ambassadors completing > 99% of the 105 intervention calls with Buddies. Results showed a signal of change in hemoglobin A1c (effect size = 0.14) and medication adherence (effect size = 0.35) among buddies, reduction in buddies’ negative beliefs about diabetes and an increase in necessity beliefs of diabetes medicines. Summative interviews with buddies showed they valued ambassador’s encouragement of self-management behaviors. ConclusionsResults support conduct of an efficacy trial to address medication adherence for African Americans with type 2 diabetes using a peer-supported tailored intervention.

scholarly journals Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH RCT

2020 ◽  
Author(s):  
Lyndsay A. Nelson ◽  
Robert A. Greevy ◽  
Andrew Spieker ◽  
Kenneth A. Wallston ◽  
Tom A. Elasy ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Self Efficacy ◽  
Text Messaging ◽  
Self Care ◽  
Baseline Hba1c ◽  
Median Response ◽  
Text Messaging Intervention

<b>Objective:</b> Text messaging interventions have high potential for scalability and to reduce health disparities; however, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention. <p><b>Research Design and Methods:</b> Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized trial, assigned to receive REACH (Rapid Education/Encouragement and Communications for Health) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence, and non-tailored texts supporting other self-care behaviors. Outcomes included HbA1c, diabetes medication adherence, self-care, and self-efficacy. </p> <p><b>Results:</b> Participants (N=506) were approximately half racial/ethnic minority and half were underinsured, had annual household incomes <$35,000 USD and ≤ high school education; 11% were homeless. <a>Average baseline HbA1c was 8.6%±1.8%; 70.0±19.7 mmol/mol) with n<i>=</i>219 having HbA1c≥8.5% (69 mmol/mol)</a> and half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (-0.31%; 95% CI [-0.61%, -0.02%]) was greater among those with baseline HbA1c≥8.5% (-0.74%; 95% CI [-1.26%, -0.23%]), and there was not evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months, and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements. </p> <p><b>Conclusions:</b> REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain effects. </p>

Medication Adherence and Associated Hemoglobin A1c in Type 2 Diabetes

2004 ◽  
Vol 38 (9) ◽  
pp. 1357-1362 ◽  
Author(s):  
Kimberley Krapek ◽  
Kathleen King ◽  
Susan S Warren ◽  
Karen G George ◽  
Dorothy A Caputo ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Hemoglobin A1c

Medication Adherence and Diabetes Control in Urban African Americans With Type 2 Diabetes.

2005 ◽  
Vol 24 (4) ◽  
pp. 349-357 ◽  
Author(s):  
Felicia Hill-Briggs ◽  
Tiffany L. Gary ◽  
Lee R. Bone ◽  
Martha N. Hill ◽  
David M. Levine ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
African Americans ◽  
Diabetes Control

scholarly journals Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH RCT

2020 ◽  
Author(s):  
Lyndsay A. Nelson ◽  
Robert A. Greevy ◽  
Andrew Spieker ◽  
Kenneth A. Wallston ◽  
Tom A. Elasy ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Self Efficacy ◽  
Text Messaging ◽  
Self Care ◽  
Baseline Hba1c ◽  
Median Response ◽  
Text Messaging Intervention

<b>Objective:</b> Text messaging interventions have high potential for scalability and to reduce health disparities; however, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention. <p><b>Research Design and Methods:</b> Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized trial, assigned to receive REACH (Rapid Education/Encouragement and Communications for Health) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence, and non-tailored texts supporting other self-care behaviors. Outcomes included HbA1c, diabetes medication adherence, self-care, and self-efficacy. </p> <p><b>Results:</b> Participants (N=506) were approximately half racial/ethnic minority and half were underinsured, had annual household incomes <$35,000 USD and ≤ high school education; 11% were homeless. <a>Average baseline HbA1c was 8.6%±1.8%; 70.0±19.7 mmol/mol) with n<i>=</i>219 having HbA1c≥8.5% (69 mmol/mol)</a> and half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (-0.31%; 95% CI [-0.61%, -0.02%]) was greater among those with baseline HbA1c≥8.5% (-0.74%; 95% CI [-1.26%, -0.23%]), and there was not evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months, and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements. </p> <p><b>Conclusions:</b> REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain effects. </p>

scholarly journals Feasibility of a Texting Intervention to Improve Medication Adherence Among Older HIV+ African Americans: A Mixed-Method Pilot Study

2019 ◽  
Vol 5 ◽  
pp. 233372141985566 ◽  
Author(s):  
Marta E. Pagan-Ortiz ◽  
Paul Goulet ◽  
Laura Kogelman ◽  
Sue E. Levkoff ◽  
Patricia Flynn Weitzman
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
African Americans ◽  
Mixed Method ◽  
Self Efficacy ◽  
Text Messaging ◽  
The United States ◽  
Self Report ◽  
Art Adherence ◽  
Older African Americans

Antiretroviral therapy (ART) is the primary treatment for HIV, and adherence to it is crucial to addressing health disparities. Approximately half of individuals in the United States living with HIV are African Americans, and those over 45 years of age are more likely to die early from HIV/AIDS than their White counterparts. This mixed-method pilot study evaluated the feasibility of a text-based mobile phone intervention designed to improve ART adherence among older African Americans with HIV. Feasibility was assessed via implementation, participant adherence, acceptability, and satisfaction, as well as short-term impact on medication adherence, adherence-related self-efficacy, and positive affect. The intervention utilized pill reminder, motivational, and health educational texts. Participants ( N = 21) ranged in age from 50 to 68 years. Outcomes were evaluated via quantitative results from self-report measures and qualitative data from four focus groups. There was no attrition in participation. After 8 weeks, participants reported statistically significant improvements in medication adherence, but not in self-efficacy or affect scores. Qualitative findings highlight the psychologically supportive potential of the intervention, challenges to adherence, as well as suggestions for improvement. The study demonstrates that a text messaging intervention may be feasible for older African Americans with HIV, and helpful in supporting ART adherence.

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