Definition of Self-Management Support  An intervention comprising techniques, tools, and programs to help patients choose and maintain healthy behaviors.  A fundamental transformation of the patient-caregiver relationship into a collaborative partnership.

A Brief Review of Literature

Sustaining short-term improvements over the long-term  A 2-year diabetes self-management support (DSMS) intervention  An empowerment-based DSMS model can sustain or improve diabetes-related health gains achieved from previous short-term DSME Tang et al, Diabetes Res Clin Pract, 2012

Self-management support in “real-world” settings: An empowerment-based intervention  an empowerment-based, DSMS intervention is promising for improving and/or maintaining diabetes-related health, particularly A1C. Tang et al, Patient Educ Couns, 2010

Who could provide DSMS?

Training peers to provide ongoing diabetes self-management support (DSMS): Results from a pilot study  it is feasible to train and graduate peer leaders with the necessary knowledge and skills to facilitate DSMS interventions.  With proper training, peer support may be a viable model for translating and sustaining DSMS interventions into community-based settings Tang et al, Patient Educ Couns, 2011

PRISM study: Who Can Provide Diabetes Self-Management Support in Primary Care? regardless of DSMS supporter  following DSME, participants maintained improved glycemia, lipid, weight, and self-care behaviors and reductions in distress throughout the delivery of DSMS interventions regardless of DSMS supporter.  All of the participants reported satisfaction with DSMS. Siminerio et al, The Diabetes Educator,2013

Continuum Strategies to Support Self-management From The Health Foundation. Evidence: helping people help themselves. London: The Health Foundation, 2011

Incorporating SMS into Practice 1. Prioritize most immediate and important problem 2. Working on readiness to change: Importance and Confidence 3. Developing an action plan 4. Commit to action 5. Experience and evaluate the plan: problem solving skills

Gabric and Farir Teb Tele-Education:  Gabric commitment to improve its diabetes school model  Gabric strategy to expand to other cities  Farir Teb strategy to develop/support innovative diabetes education programs  Difficulties for diabetic patients to come to Gabric office  Need for systematic 1-to-1 peer-counselor support(DSMS)

Test of Idea (Phase 1)  To assess the satisfaction of participants from support of 1- to-1 peer supporter  How effective knowledge is transferred via Tele-Education  Improvement in related behaviors  Change in metabolic factors

Structure:  Educational booklet  4 educational/coaching sessions(30 min. each) by peer- counselor from Gabric  Length: 11 days  7 educational modules

Session Structure:  Opening  Motivational interviewing  Follow up on last sessions goals  Q&A of previously discussed topics  Body  Education of modules  Interactive SMART goal setting  Conclusion  Review of goals and action plan  Q&A Empathy Active Listening

Educational Modules:  Importance of diabetes education, BS balance  SMBG, Target BS  Nutrition 1(Fiber, 6 meals, …)  Nutrition 2(Nutrition pyramid, Healthy plate)  Exercise  ABC management, Preventing complications  Insulin My Friend

Problem-Solving Based Modules Structure  Identifying the problem(Why)  Knowledge/Tools(How)  Interactive SMART goal setting(I PROMISE ….)  Recording/Evaluation and feedback

Results  16 people started the program  12 people(75%) finished the program on schedule  Telephone feedback after a week

Results  100% evaluated the program as EXCEPTIONAL  Effects of the program on your blood sugar:  VERY GOOD(55%)  GOOD(33%)  NO EFFECT(12%)  100% recommend it to others  81% of behavioral goals were met

Results  100% gave full evaluation grade to peer-counselor  Why:  KIND  PAITENT  RESPONSIBLE Empathy Active Listening

Pilot Program(Phase 2) We would like to know your comments on  Which target group of patients  Your priority for educational/behavioral modules  Employing peer-counselors who are not HCP  Benefits  Notes to be considered  Overall evaluation of this program  Recommendation and suggestions