Community partnerships in Detroit, Flint, and Toledo will create church-based models of support for people with diabetes
For people living with diabetes or at risk of developing it, education on how to self-manage the condition is an essential part of their care. Improved knowledge and self-care behavior, along with better clinical outcomes, quality of life, use of primary and preventive services, and lower costs are well-documented upshots of this intervention.
The problem is that without continued follow-up and support, the gains realized by diabetes self-management education (DSME) are short-lived. And although DSME is a covered benefit of the health system, diabetes self-management support (DSMS) – those ongoing support services that really help improved outcomes stick for the long term – are not, even though both DSME and DSMS are recognized as standards of care by the American Diabetes Association. This ultimately limits access and availability of DSMS programs, especially among low-income African Americans.
Under a five-year, $3.2 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a U-M team will partner with a network of 21 churches in Detroit and Flint, Michigan, and Toledo, Ohio, to help develop sustainable, responsive diabetes support programs that offer a new approach to addressing diabetes-related disparities in underserved communities.
The study, led by Gretchen Piatt, Ph.D., M.P.H., assistant professor of learning health sciences, U-M Medical School, will train parish nurses and peer leaders to facilitate and provide DSMS to parishioners with type 2 diabetes, in the form of support group sessions. The study will have three arms to evaluate the effectiveness of parish nurse-led DSMS, peer leader-led DSMS, and DSMS facilitated by both peer leaders and nurses.
It’s not commonly known that several churches, of all denominations, have parish nurses as part of their health ministry, while others have nurses in their congregation who serve the parish in a volunteer capacity. The American Nursing Association offers certification in faith/community nursing, creating a potentially sustainable community infrastructure to provide diabetes support.
Peer leaders, who are parish members managing their own diabetes, are also particularly well-positioned to provide support to others in their church who are living with the illness, as they are also likely experiencing the ups and downs that often accompany it, and can empathize with their fellow parish members’ situations.
“Self-management support really focuses on the emotions around diabetes, and on implementing the behavior changes and coping skills to self-manage on an ongoing basis,” Piatt says. “That’s why peer leaders are really good at delivering support, because they understand the condition so well.”
In the year following the educational and support interventions, the study will evaluate whether churches continue the programs using the tools and training provided, and which factors are key for successful uptake and sustainability. The study will also evaluate the interventions’ effectiveness in improving a variety of diabetes-related patient outcomes, as well as their cost effectiveness and long-term impact.
The project builds on previous work by Piatt’s team over the past three years that trained peer leaders in nine churches in metro Detroit on facilitating and delivering DSMS, on top of the U-M Learning Health Sciences Department’s two decades of experience working with Detroit community groups on a variety of diabetes-related issues.
“The people we’ve encountered over the years all say they want diabetes support that’s ongoing and responsive to their needs, and lets them receive services in a familiar setting with people they know,” Piatt says, noting that of the 14 locations in metro Detroit that offer diabetes self-management education, none offers self-management support. “We hope that utilizing the existing church infrastructure in communities where these institutions have such important role will foster effective and lasting support programs.”