Social Support Strategies in Adult Patients With Diabetes

A Review of Strategies in the USA and Europe

Julienne K Kirk; Christine N Ebert; Ginger P Gamble; C Edward Ebert


Expert Rev Endocrinol Metab. 2013;8(4):379-389. 

In This Article

Social Support & Peer Influence

Peer Support Influence

While family and friends are often both readily accessible and economically viable options to help patients achieve adherence, the utility of this choice is not always feasible for patients. Peer support is another alternative to help engage the patient with diabetes. For many patients, the involvement of a healthcare professional or an agent who had experienced conditions similar to the patient in their support network may improve overall diabetes self-management. Peer support can be defined as follows: 'support from a person who has experiential knowledge of a specific behavior or stressor and similar characteristics as the target population'.[18] Peer support can vary from a healthcare professional to a community health worker.

Incorporation of peer support can be structured in a variety of schemes, and several studies have examined the feasibility of these methods. In a study protocol, Paul et al. outlined methods that encapsulate three primary aspects of peer support, the effect of peer support on behavioral and/or health outcomes, psychosocial outcomes and economic efficiency.[19] Peer support can be a bridge between healthcare workers and patients. They found that there were four key components to effective peer support, which include recruiting, training and retaining peer supporters while having regular meetings.[19] Building on this framework, Fisher et al. states that the roles of peer supporters are to assist in daily management of disease, provide emotional/social support and link patients to clinical care.[20]

Provided that the peer supporters reflect an empathetic approach to patients, offer practical advice and are involved in patient decision-making with an individualized and part of ongoing group support, outcomes can be positively influenced.[21] A recent review of 25 randomized, controlled or comparative studies by Dale et al. was researched from 1966 to 2011 and provides details on the effect of peer support on diabetes outcomes in adults.[22] Peer support was associated with statistically significant improvements in glycemic control, BP, cholesterol, weight, physical activity, self-efficacy, depression and perceived social support found in a few of the studies. There was no specific or consistent pattern of effect related to the use of peer support and outcomes.

Recent studies have also focused on involving peer support networks in addition to healthcare professionals to engage patients to reinforce self-management behaviors. Focus groups of 19 patients have been conducted with diabetes to assess themes of perceived healthcare, and ongoing group-based support was identified as a way to enhance motivation.[21] A large randomized study of 20 general practices carried out by Smith et al., involving 395 patients and 29 peer supporters with diabetes, was evaluated for outcomes of A1C, cholesterol, BP and wellbeing score.[23] While a group-based peer support was shown to be feasible and outcomes trended toward improvement, this intervention did not significantly improve outcomes among practices in Ireland. This could reflect the novelty of developing peer support networks and the need for optimization, as well as personalization.

A number of studies have examined how different variables among patients affect results. In a study of veterans, where reciprocal peer support was compared with support by nurse care managers, veterans were paired with each other as support partners.[24] While A1C levels exhibited little change between the two groups, the peer support cohort expressed significantly greater feelings of support. Physiologically there was no change, but psychologically there was greater satisfaction with peer support. Another study of AA veterans in the USA found a small improvement in glucose control among patients assigned to a peer mentoring group.[25]

Another research involving surveys among AA and Latino patients indicated in multivariate models that professional support from nonphysicians was significantly associated with increased levels of diabetes meal plan and checking of the feet.[16] Another study of Mexican Americans showed no clinical difference in health outcomes, but found that this population responded more favorably to face-to-face meetings with nurse care managers in the role of peer support.[26] Finally, in South Africa, where the healthcare options for diabetes management are widely regarded as substandard, a study examined women who were provided with buddies via mobile phones and how interactions between partners influenced diabetes management.[27] Again, overall physiological effects showed no difference between those with peer support and those without; in fact, the only significant difference in all physiological behavioral factors tracked was in the number of hours slept per night. This could indicate a reduction in anxiety about the disease, but a more definitive analysis would be needed to be certain.

The manner in which peer support is arrayed and how information is communicated between support members and patients may account for the variances observed in the prior studies. A study categorized physician support as either practical, such as goal setting or proactive follow-up, or communicative, such as empathic listening, eliciting preferences.[28] Results indicated that practical support resulted in improved levels of glycemic control, while communicative support had no effect. Although this study was limited to physician-based support, the idea of practical versus communicative support among peer supporters is intriguing and bears investigation.

An analysis of how peer supporters provide information may shed light on ways to impact diabetes outcomes. While tightly controlled populations may have specifically unusual results, the general effects of peer support may lend optimal support for patients who can afford this option. Although the outcomes of peer support are not clearly known, patients consistently report feeling benefits of peer support