 family and friends and how to not let diabetes diminish their cultural experience.
Q: Where do you hope to take Peers LEAD?
A: Based on that pilot, we are now incorporating what we learned from Peers LEAD into Healthy Living with Diabetes, a six-week diabetes self-management education (DSME) program open to anyone with prediabetes or type 2 diabetes in Wisconsin and focused on topics such as diet and exercise. We call the integrated program Peers EXCEL.
We piloted Peers EXCEL with six people, and we have received funding to do a pilot randomized control trial comparing Peers EXCEL with the current DSME program. We’re in the process of screening participants for that trial.
Right now, African Americans are underrepresented in Wisconsin’s DSME program. We hope to reduce this disparity by integrating into the DSME program the cultural tailoring of Peers EXCEL, which addresses African American beliefs and misperceptions around medication use.
Q: What can health care professionals do to improve medication adherence among their patients?
A: A lot of misinformation can be avoided when providers take time to marry the biomedical model of what causes diabetes and their biological knowledge of medicines with the cultural beliefs and perceptions that the patient has.
Building trust is also important. If there is not that therapeutic alliance with the provider, the patient is going to go home and not trust the medicine they were prescribed. Using health literacy tools, while speaking in simple clear language, is a bridge to building trust.
People told us that they do not know what questions to ask their providers. So empowering patients to ask questions is also an important thing for healthcare professionals to do.
Q: How do health care professionals find the time for this kind of trust building and communication?
A: In the U.S. healthcare system, clinicians may not have that time. So, we need to increase referrals to diabetes educators and culturally tailored diabetes self-management programs.
Also, asking simple, open-ended questions, like, “What questions do you have?” might take two minutes. Incorporating teach-back into clinical visits (“If you went home, what would you tell your family member about what we talked about during our visit today?”) can be a time saver, in getting patients to voice their concerns.