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Telephone-Based Mentoring From Demographically Similar Peers Improves Diabetes Control in African-American Veterans


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Peer Mentoring is a Culturally Competent Strategy to Improve Diabetes Self-Management Among African-American Men

By Concepcion Trevino James, MA
Manager of Reducing Health Disparities for Contra Costa Health Services
Martinez, CA


Diabetes is a serious health problem for many African Americans. Compared with the general population, African Americans are disproportionately affected by diabetes. The Centers for Disease Control and Prevention estimated that 4.9 million African-American adults or 18.7 percent of all African Americans 20 years or older in 2010 had diabetes.1 Furthermore, African Americans are more likely than whites to have medical complications from poorly managed diabetes, including blindness (retinopathy), kidney disease, and amputations. African Americans are 2.7 times as likely as non-Hispanic whites to suffer from lower-limb amputations and men with diabetes are 1.4 to 2.7 times more likely than women with diabetes to have amputations, according to the American Diabetes Association.2

The Philadelphia VA Medical Center’s focus on diabetes management for African-American men, and use of peer mentoring based on the community health worker model was an effective strategy to reduce blood glucose levels. The model facilitates cultural competence by matching trained laypeople with communities of similar racial/ethnic or cultural backgrounds.

The Philadelphia VA Medical Center trained African-American men who had successfully managed their diabetes to mentor other African-American men with poor glucose control to improve their diabetes management. This approach was more successful than the usual care control group and the group that received only financial incentives. About two-thirds of the mentored men indicated at the end of the 6-month program that they thought it was important that their mentors had diabetes. In addition, the men shared a common professional history as military veterans, although that component was not evaluated.

At Contra Costa Health Services, we have found culturally competent patient groups to be effective in helping Latino and African-American patients (predominately women) self-manage their type 2 diabetes and navigate the health care system. The groups consist of six sessions that are co-facilitated by a family physician and either a Latina promoter or an African-American health conductor (health navigators), depending on the racial makeup of the group. The promoters and health conductors support the family physician by ensuring that the curriculum and group processes/activities are culturally relevant and appropriate. The health navigators also help group participants learn how to communicate with their doctors, co-facilitate group activities, and make weekly phone calls to participants to monitor their progress in achieving their session-specific action plans. The goal is to help participants increase their knowledge, skills, and confidence in managing their diabetes. The sessions focus on a medical pullout (where the doctor reviews the patient’s clinical health issues), health education, group support, developing realistic action plans, and weekly phone calls. A family physician also demonstrates how to give oneself an injection of insulin to help patients overcome their fear of self-injections. Preliminary findings of an evaluation of these groups have confirmed a decrease in LDL (cholesterol levels) and A1C (glucose levels).

Another unique aspect of the VA peer mentoring program was that the mentoring sessions were conducted primarily by telephone rather than in person. This may be convenient for some patients who live far away from the clinic. I would be interested to know whether men preferred phone calls to a group intervention held at a clinic.

The VA program also paid 38 mentors incentives up to $200 each to participate in the entire 6-month trial. Because this is not a large dollar amount, other motivating factors may have been present, including the desire to help other veterans and set a good example for them by maintaining diabetes control.

Reimbursement of individual telephone sessions by third parties would be important to sustain this program long-term. Federally Qualified Health Centers such as ours are reimbursed for group peer sessions. If we adopted this mentoring strategy for male patients, we would try to pair mentors from previous sessions who had successfully managed their diabetes with their peers in current group sessions. We would use the telephone calls as an adjunct to the group and the health navigator phone calls. It would be interesting to see if we achieved the same or better positive outcomes.

About the Author: Concepcion James, MA, has more than 25 years of experience managing social services and health services for low income-communities of color.  She has overseen the Contra Costa Health Services Promotora and African-American Health Conductor programs since their inception in 2000 and 2005.  

Disclosure Statement:
Concepcion James, MA, is aware of the requirement to disclose potential conflicts of interest. She reported no financial interests, or professional or business affiliations relevant to the work described in this commentary.


References

1Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.).

2American Diabetes Association. Living with Diabetes: African Americans and Complications. Available at: http://www.diabetes.org/living-with-diabetes/complications/african-americans-and-complications.html.

Original publication: July 18, 2012.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: July 17, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.