Complementarity of Digital Health and Peer Support: "This Is What's Coming"

Patrick Y Tang; Janet Duni; Malinda M Peeples; Sarah D Kowitt; Nivedita L Bhushan; Rebeccah L Sokol; Edwin B Fisher

doi:10.3389/fcdhc.2021.646963

Complementarity of Digital Health and Peer Support: "This Is What's Coming"

Front Clin Diabetes Healthc. 2021 Sep 24:2:646963. doi: 10.3389/fcdhc.2021.646963. eCollection 2021.

Authors

Patrick Y Tang¹, Janet Duni², Malinda M Peeples³, Sarah D Kowitt¹, Nivedita L Bhushan¹, Rebeccah L Sokol¹, Edwin B Fisher¹

Affiliations

¹ Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
² Population Health Team, Vanguard Medical Group, Verona, NJ, United States.
³ Clinical Services and Research, WellDoc, Inc., Columbia, MD, United States.

Abstract

Purpose: This study examined integration of peer support and a Food and Drug Administration-cleared, diabetes management app (DMA) in diabetes self-management support as a scalable model for those with type 2 diabetes mellitus (T2DM).

Methods: Two lay health Coaches delivered telephone-based self-management support to adults (N = 43) with T2DM recruited through a primary group practice. Those eligible were offered no-cost access to DMA for the entire 6-month study. Coaches introduced DMA and contacted individuals by phone and text with frequency dependent on participant needs/preferences. DMA supported monitoring of blood glucose, carbohydrate intake, and medication use, as well as messaging personalized to participants' medication regimens. Clinical data were extracted from DMA, electronic medical records, and Coaches' records. Structured interviews of 12 participants, 2 Coaches, and 5 project staff were analyzed using deductive pre-identified codes (regarding adoptability, patterns of use, value added, complementarity, and sustainability) utilizing standard procedures for qualitative analysis.

Results: Of the 43 participants, 38 (88.4%) enrolled in DMA. In general, participants used both DMA and lay health coaches, averaging 144.14 DMA entries (structured, e.g., medications, and free form, e.g., "ate at a restaurant" and "stressed") and 5.86 coach contacts over the 6-month intervention. Correlation between DMA entries and coach contacts (r = .613, p < 0.001) was consistent with complementarity as were participants' and coaches' observations that (a) DMA facilitated recognition of patterns and provided reminders and suggestions to achieve self-management plans, whereas (b) coaching provided motivation and addressed challenges that emerged. Mean hemoglobin A1c (A1c) declined from 9.93% to 8.86% (p < 0.001), with no pattern of coaching or DMA use significantly related to reductions. Staff identified resources to coordinate coach/DMA interventions as a major sustainability challenge.

Conclusions: DMA and peer support for diabetes management are compatible and complementary. Additional practice integration research is needed for adoption and scale-up.

Keywords: app; coach; diabetes; digital health; peer support; primary care; self-management; telephone.