re African Americans with type 2 diabetes whom we had screened for having challenges with taking medicines.
We had a pharmacist come in and talk about beliefs around medicines—explaining why medicines are necessary and addressing concerns about side effects or the effectiveness of medicines. We had a physician talk about A1C and what those numbers actually mean. Then we had a diabetes educator address myths and misinformation.
We spent time in open discussion: “Tell us, what have you heard about diabetes and what causes it?” Then we tried to reframe using motivational interviewing techniques and reframing language. We validate the belief; we don’t discount it or make it look like it’s an ignorant misperception. We might say, “We understand why you might think this way. However, we also know that there are so many reasons why a patient might get diabetes.” We link that belief to the biomedical model and spend time talking about diet and exercise.
Health literacy is a huge component of Peers LEAD. Our participants really appreciated the time we took to break down information using pictures and plain language, making sure that they clearly understood all they needed to know about their diabetes diagnosis and medicines.
Sometimes it was other people in the room who helped invalidate misperceptions. Someone might say, “That’s not what I heard from my own family.” It made it a little easier to address misperceptions when this was coming from trusted lay persons.
In addition to the group sessions, we brought in individuals we call ambassadors. These are African Americans who have type 2 diabetes and have been screened for being adherent to their medicines. We matched them on a one-to-one basis with a buddy. The ambassadors came to the group education sessions, and they also talked with their buddies on the phone, using a standardized manual, about beliefs and misperceptions. They provided positive role modeling—sharing their self-management strategies around medication use and talking about how to discuss medicines with 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-end