Title : Implementing a peer-led self-management program to slow down/ prevent progression of frailty
Abstract:
The Telephone Self-Management Coach Program was developed in 2014 by Self-Management BC and since then has been implemented to nearly 3,000 seniors experiencing difficulty managing chronic health conditions. Two studies have been conducted to validate the feasibility, viability and effectiveness of self-management peer coaching with seniors. The first longitudinal study (2017-2019), found that a pragmatic low-cost telephone self-management peer coaching intervention assisted persons with type 2 diabetes to improve healthy behaviours and better self-manage their diabetes.
The second study (2019-21), a RCT, evaluated the relative effectiveness of using peer coaches compared to using coaches where participants were also provided with three assistive devices, namely: a wrist watch; a scale which tracked weight, heart rate, body composition and environmental data; and a sleep pad that tracked sleep cycles. Several results stood out, namely that participants who worked with a coach (alone) reported decreased depression, higher activation levels, better handling of role limitations due to physical health, higher energy levels, better social functioning, and better communication with their physician. Participants who had devices along with a coach showed similar improvements on all of these measures, with even larger decreases in depression severity. In addition, participants with devices also improved in terms of their self-efficacy, better handling of role limitations due to emotional problems, higher level of emotional well-being, lower pain, and higher general health ratings. None of the covariates tested - sex, age, education level and number of chronic conditions - contributed to the differences in outcome measures. The additional use of home-based electronic devices connected to an app showed further benefits. These results held for all participants and were not impacted by the COVID-19 interruption, nor were there differential effects based on age, sex and education level.
The key implication for public health practice and policy is that a relatively inexpensive, easy to implement peer-delivered telephone Self-Management Health Coach Program has been shown to be effective in helping people with chronic health conditions manage their health outcomes, even without devices. Adding the devices further enhanced the experiences of the participants. The shortage of general practitioners could be eased by incorporating peer coaches, with or without the devices, to help patients, likely of all ages, manage their chronic health issues. A third study, which will start in the Spring of 2023, will implement and evaluate a community peer-led coaching three-month weekly intervention that may slow down and/or prevent the progression of frailty in older adults. The intervention will include teaching participants to use self-management support strategies and provision of education on incorporating the Canadian Frailty Network AVOID strategy into their lives. This presentation will describe the intervention, how it will be implemented, study design and outcome measures used in the previous studies and in the future study, and some key lessons learned conducting this research over the past six years.
