Effect of a brief, regular telephone intervention by paraprofessionals for type 2 diabetes

  • William P. Sacco
  • John I. Malone
  • Anthony D. Morrison
  • Andrea Friedman
  • Kristen Wells
Article

Abstract

Brief, cost-effective interventions to promote diabetes self-management are needed. This study evaluated the effects of a brief, regular, proactive, telephone “coaching” intervention delivered by paraprofessionals on diabetes adherence, glycemic control, diabetes-related medical symptoms, and depressive symptoms. Therapeutic mechanisms underlying the intervention’s effect on the primary outcomes were also examined. Adults diagnosed with type 2 diabetes (N = 62) were randomly assigned to receive the “coaching” intervention and treatment as usual, or only treatment as usual. The intervention increased frequency of exercise and feet inspection, improved diet, reduced diabetes medical symptoms, and lowered depressive symptoms. Self-efficacy, reinforcement, and awareness of self-care goals mediated the treatment effect on depression, exercise, and feet inspection, respectively. A brief telephone intervention delivered by paraprofessionals had positive effects on type 2 diabetes patients.

Keywords

Diabetes Telephone intervention Paraprofessionals Adherence Depression Diabetes symptoms 

References

  1. Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care, 24, 1069–1078. doi:10.2337/diacare.24.6.1069.PubMedCrossRefGoogle Scholar
  2. Apelqvist, J., & Larsson, J. (2000). What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes/Metabolism Research and Reviews, 16(Suppl. 1), S75–S83. doi10.1002/1520-7560(200009/10)16:1+<::AID-DMRR139>3.0.CO;2-8.PubMedCrossRefGoogle Scholar
  3. Bandura, A. (1998). Health promotion from the perspective of social-cognitive theory. Psychology & Health, 13, 623–649. doi:10.1080/08870449808407422.CrossRefGoogle Scholar
  4. Bandura, A., Pastorelli, C., Barbaranelli, C., & Caprara, G. V. (1999). Self-efficacy pathways to childhood depression. Journal of Personality and Social Psychology, 76, 258–269. doi:10.1037/0022-3514.76.2.258.PubMedCrossRefGoogle Scholar
  5. Brown, S. A. (1990). Studies of educational interventions and outcomes in diabetic adults: A meta-analysis revisited. Patient Education & Counseling, 16(3), 189–215.CrossRefGoogle Scholar
  6. Brown, D. W., Balluz, L. S., Giles, W. H., Beckles, G. L., Moriarty, D. G., Ford, E. S., et al. (2004). Diabetes mellitus and health-related quality of life among older adults: Findings from the behavioral risk factor surveillance system (BRFSS). Diabetes Research and Clinical Practice, 65, 105–115. doi:10.1016/j.diabres.2003.11.014.PubMedCrossRefGoogle Scholar
  7. Carver, C. S., & Scheier, M. F. (1999). Control theory: A useful conceptual framework for personality-social, clinical, and health psychology. In R. F. Baumeister, et al. (Eds.), The self in social psychology (pp. 299–316). Philadelphia: Psychology Press/Taylor & Francis.Google Scholar
  8. Christensen, A., & Jacobson, N. S. (1994). Who (or what) can do psychotherapy: The status and challenge of nonprofessional therapies. Psychological Science, 5, 8–14. doi:10.1111/j.1467-9280.1994.tb00606.x.CrossRefGoogle Scholar
  9. Ciechanowski, P. S., Katon, W. J., & Russo, J. E. (2000). Depression and diabetes: Impact of depressive symptoms on adherence, function, and costs. Archives of Internal Medicine, 160, 3278–3283. doi:10.1001/archinte.160.21.3278.PubMedCrossRefGoogle Scholar
  10. Cowie, C. C., Rust, K. F., Byrd-Holt, D. D., Eberhardt, M. S., Flegal, K. M., Engelgau, M. M., et al. (2006). Prevalence of diabetes and impaired fasting glucose in adults in the US population: National Health and Nutrition Examination Survey 1999–2002. Diabetes Care, 29, 1263–1268. doi:10.2337/dc06-0062.PubMedCrossRefGoogle Scholar
  11. de Groot, M., Anderson, R., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001). Association of depression and diabetes complications: A meta-analysis. Psychosomatic Medicine, 63, 619–630.PubMedGoogle Scholar
  12. DiMatteo, M. (2004). Variations in patients’ adherence to medical recommendations: A quantitative review of 50 years of research. Medical Care, 42(3), 200–209. doi:10.1097/01.mlr.0000114908.90348.f9.PubMedCrossRefGoogle Scholar
  13. Eakin, E. G., Lawler, S. P., Vandelanotte, C., & Owen, N. (2007). Telephone interventions for physical activity and dietary behavior change: A systematic review. American Journal of Preventive Medicine, 32, 419–434. doi:10.1016/j.amepre.2007.01.004.PubMedCrossRefGoogle Scholar
  14. Eddy, D. M., Schlessinger, L., & Kahn, R. (2005). Clinical outcomes and cost-effectiveness of strategies for managing people at high risk for diabetes. Annals of Internal Medicine, 143(4), 251–264.PubMedGoogle Scholar
  15. Egede, L. E., Nietert, P. J., & Zheng, D. (2005). Depression and all-cause and coronary heart disease mortality among adults with and without diabetes. Diabetes Care, 28, 1339–1345. doi:10.2337/diacare.28.6.1339.PubMedCrossRefGoogle Scholar
  16. Engum, A., Mykletun, A., Midthjell, K., Holen, A., & Dahl, A. A. (2005). Depression and diabetes: A large population-based study of sociodemographic, lifestyle, and clinical factors associated with depression in type 1 and type 2 diabetes. Diabetes Care, 28, 1904–1909. doi:10.2337/diacare.28.8.1904.PubMedCrossRefGoogle Scholar
  17. Fertig, B. J., Simmons, D. A., & Martin, D. B. (1995). Therapy for diabetes. In National Diabetes Data Group (Ed.), Diabetes in America (2nd ed.). Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Google Scholar
  18. Fisher, E., Arfken, C., Heins, J., Houston, C., Jeffe, D., & Sykes, R. (1997). Acceptance of diabetes regimens in adults. In Handbook of health behavior research II: Provider determinants (pp. 189–212). New York: Plenum Press.Google Scholar
  19. Fitzgerald, J. T., Funnell, M. M., Hess, G. E., Barr, P. A., Anderson, R. M., Hiss, R. G., et al. (1998). The reliability and validity of a brief diabetes knowledge test. Diabetes Care, 21(5), 706–710. doi:10.2337/diacare.21.5.706.PubMedCrossRefGoogle Scholar
  20. Foreyt, J. P., & Poston, W. S. C., I. I. (1999). The challenge of diet, exercise and lifestyle modification in the management of the obese diabetic patient. International Journal of Obesity and Related Metabolic Disorders, 23, S5–S11. doi:10.1038/sj.ijo.0800955.PubMedCrossRefGoogle Scholar
  21. Friedman, A., Wells, K., Steiner, P., Malone, J., Morrison, A., & Sacco, W. P. (2003). Can a paraprofessional telephone coaching intervention improve exercise and foot care adherence in type 2 diabetes patients? Annals of Behavioral Medicine, 25, S 28.Google Scholar
  22. Gallant, M. P. (2003). The influence of social support on chronic illness self-management: A review and directions for research. Health Education & Behavior, 30, 170–195. doi:10.1177/1090198102251030.CrossRefGoogle Scholar
  23. Gilmer, T. P., O’Connor, P. J., Rush, W. A., Lauren Crain, A., Whitebird, R. R., Hanson, A. M., et al. (2005). Predictors of health care costs in adults with diabetes. Diabetes Care, 28, 59–64. doi:10.2337/diacare.28.1.59.PubMedCrossRefGoogle Scholar
  24. Glasgow, R. E., & Eakin, E. G. (1998). Issues in diabetes self-management. In S. A. Shumaker, E. B. Schron, et al. (Eds.), The handbook of health behavior change (2nd ed., pp. 435–461). New York: Springer Publishing Co.Google Scholar
  25. Glasgow, R. E., Marrero, D., Fisher, E. B., Johnson, S. B., Anderson, B. J., Rubin, R. R., et al. (1999). Behavioral science in diabetes. Diabetes Care, 22, 832–843. doi:10.2337/diacare.22.5.832.PubMedCrossRefGoogle Scholar
  26. Gollwitzer, P. M. (1999). Implementation intentions: Strong effects of simple plans. The American Psychologist, 54, 493–503. doi:10.1037/0003-066X.54.7.493.CrossRefGoogle Scholar
  27. Grootenhuis, P. A., Snoek, F. J., Heine, R. J., & Bouter, L. M. (1994). Development of a Type 2 diabetes symptom checklist: A measure of symptom severity. Diabetic Medicine, 11, 253–261.PubMedCrossRefGoogle Scholar
  28. Gucciardi, E., De Melo, M., Offenheim, A., Grace, S., & Stewart, D. (2007). Patient factors associated with attrition from a self-management education programme? Journal of Evaluation in Clinical Practice, 13(6), 913–919.PubMedGoogle Scholar
  29. Hattie, J. A., Sharpley, C. F., & Rogers, H. J. (1984). Comparative effectiveness of professional and paraprofessional helpers. Psychological Bulletin, 95, 534–541. doi:10.1037/0033-2909.95.3.534.PubMedCrossRefGoogle Scholar
  30. King, A., Friedman, R., Marcus, B., Castro, C., Napolitano, M., Ahn, D., et al. (2007). Ongoing physical activity advice by humans versus computers: The Community Health Advice by Telephone (CHAT) Trial. Health Psychology, 26(6), 718–727. doi:10.1037/0278-6133.26.6.718.PubMedCrossRefGoogle Scholar
  31. Kirkman, M. S., Weinberger, M., Landsman, P. B., Samsa, G. P., Shortliffe, E. A., Simel, D. L., et al. (1994). A telephone-delivered intervention for patients with NIDDM: Effect on coronary risk factors. Diabetes Care, 17(8), 840–846. doi:10.2337/diacare.17.8.840.PubMedCrossRefGoogle Scholar
  32. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. doi:10.1046/j.1525-1497.2001.016009606.x.PubMedCrossRefGoogle Scholar
  33. Landell-Graham, J., Yount, S. E., & Rudnicki, S. R. (2003). Diabetes mellitus. In A. M. Nezu, C. M. Nezu, & P. A. Geller (Eds.), Health psychology. I. B. Weiner (Series Ed.), Handbook of psychology, (Vol. 9). New York: John Wiley & Sons.Google Scholar
  34. Ludman, E. J., Katon, W., Russo, J., Von Korff, M., Simon, G., Ciechanowski, P., et al. (2004). Depression and diabetes symptom burden. General Hospital Psychiatry, 26, 430–436. doi:10.1016/j.genhosppsych.2004.08.010.PubMedCrossRefGoogle Scholar
  35. MacKinnon, D. P., Lockwood, M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104. doi:10.1037/1082-989X.7.1.83.PubMedCrossRefGoogle Scholar
  36. Mensing, C., et al. (2002). National standards for diabetes self-management education. Diabetes Care, 25S, S140–S147. doi:10.2337/diacare.25.2007.S140.CrossRefGoogle Scholar
  37. Norris, S. L., Engelgau, M. M., & Narayan, K. M. (2001). Effectiveness of self-management training in type 2 diabetes: A systematic review of randomized controlled trials. Diabetes Care, 24, 561–587. doi:10.2337/diacare.24.3.561.PubMedCrossRefGoogle Scholar
  38. Ortegon, M. M., Redekop, W. K., & Niessen, L. W. (2004). Cost-effectiveness of prevention and treatment of the diabetic foot: A Markov analysis. Diabetes Care, 27(4), 901–907. doi:10.2337/diacare.27.4.901.PubMedCrossRefGoogle Scholar
  39. Penninx, B., van Tilburg, T., Boeke, A., Deeg, D., Kriegsman, D., & van Eijk, J. (1998). Effects of social support and personal coping resources on depressive symptoms: Different for various chronic diseases? Health Psychology, 17, 551–558. doi:10.1037/0278-6133.17.6.551.PubMedCrossRefGoogle Scholar
  40. Piette, J. D., Weinberger, M., McPhee, S. J., Mah, C. A., Kraemer, F. B., & Crapo, L. M. (2000). Do automated calls with nurse follow-up improve self-care and glycemic control among vulnerable patients with diabetes? The American Journal of Medicine, 108(1), 20–27. doi:10.1016/S0002-9343(99)00298-3.PubMedCrossRefGoogle Scholar
  41. Pinto, B., Friedman, R., Marcus, B., Kelley, H., Tennstedt, S., & Gillman, M. (2002). Effects of a computer-based, telephone-counseling system on physical activity. American Journal of Preventive Medicine, 23(2), 113–120. doi:10.1016/S0749-3797(02)00441-5.PubMedCrossRefGoogle Scholar
  42. Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36, 717–731.Google Scholar
  43. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in simple and multiple mediator models. Behavior Research Methods, 40, 879–891. doi:10.3758/BRM.40.3.879.PubMedCrossRefGoogle Scholar
  44. Sacco, W. P., & Beck, A. T. (1995). Cognitive theory and therapy. In E. Edward Beckham & W. R. Leber (Eds.), Handbook of depression: Treatment, assessment and research (2nd ed., pp. 329–351). New York: Guilford Press.Google Scholar
  45. Sacco, W. P., Morrison, A. D., & Malone, J. I. (2004). A brief, regular, proactive telephone coaching intervention for diabetes: Rationale, description, and preliminary results. Journal of Diabetes and Its Complications, 18, 113–118. doi:10.1016/S1056-8727(02)00254-4.PubMedCrossRefGoogle Scholar
  46. Sacco, W. P., Wells, K. J., Friedman, A., Matthew, R., Perez, S., & Vaughan, C. A. (2007). Adherence, BMI, and depression in adults with type 2 diabetes: The mediational role of diabetes symptoms and self-efficacy. Health Psychology, 26, 693–700.PubMedCrossRefGoogle Scholar
  47. Sacco, W., Wells, K., Vaughan, C., Friedman, A., Perez, S., & Matthew, R. (2005). Depression in adults with type 2 diabetes: The role of adherence, body mass index, and self-efficacy. Health Psychology, 24(6), 630–634. doi:10.1037/0278-6133.24.6.630.PubMedCrossRefGoogle Scholar
  48. Sacco, W. P., & Yanover, T. (2006). Diabetes and depression: The role of social support and medical symptoms. Journal of Behavioral Medicine, 29, 523–531. doi:10.1007/s10865-006-9072-5.PubMedCrossRefGoogle Scholar
  49. Schafer, J. L. (1999). NORM: Multiple imputation of incomplete multivariate data under a normal model, version 2. Software for Windows 95/98/NT, available from http://www.stat.psu.edu/~jls/misoftwa.html.
  50. Sigal, R. J., Kenny, G. P., Wasserman, D. H., Castaneda-Sceppa, C., & White, R. D. (2006). Physical activity/exercise and Type 2 diabetes: A consensus statement from the American Diabetes Association. Diabetes Care, 29, 1433–1438. doi:10.2337/dc06-9910.PubMedCrossRefGoogle Scholar
  51. Simon, G. E., Katon, W. J., Lin, E. H. B., Rutter, C., Manning, W. G., Von Korff, M., et al. (2007). Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Archives of General Psychiatry, 64, 65–72. doi:10.1001/archpsyc.64.1.65.PubMedCrossRefGoogle Scholar
  52. Snowling, N. J., & Hopkins, W. G. (2006). Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: A meta-analysis. Diabetes Care, 29(11), 2518–2527. doi:10.2337/dc06-1317.PubMedCrossRefGoogle Scholar
  53. Sobel, M. E. (1982). Asymptotic intervals for indirect effects in structural equations models. In S. Leinghart (Ed.), Sociological methodology (pp. 290–312). San Francisco: Jossey-Bass.Google Scholar
  54. Spitzer, R. L., Kroenke, K., Williams, J. B., & The Patient Health Questionnaire Primary Care Study Group. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Journal of the American Medical Association, 282, 1737–1744. doi:10.1001/jama.282.18.1737.PubMedCrossRefGoogle Scholar
  55. Talbot, R., Nouwen, A., Gingras, J., Gosselin, M., & Audet, J. (1997). The assessment of diabetes-related cognitive and social factors: The multidimensional diabetes questionnaire. Journal of Behavioral Medicine, 20, 291–312. doi:10.1023/A:1025508928696.PubMedCrossRefGoogle Scholar
  56. Thomas, D. E., Elliott, E. J., & Naughton, G. A. (2006). Exercise for type 2 diabetes mellitus. The Cochrane Database of Systematic Reviews, 3, CD002968.Google Scholar
  57. Toobert, D. J., & Glasgow, R. E. (1994). Assessing diabetes self management: The summary of diabetes self-care activities questionnaire. In C. Bradley (Ed.), Handbook of psychology and diabetes (pp. 351–375). Chur, Switzerland: Harwood Academic.Google Scholar
  58. Toobert, D. J., Hampson, S. E., & Glasgow, R. E. (2000). The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale. Diabetes Care, 23, 943–949. doi:10.2337/diacare.23.7.943.PubMedCrossRefGoogle Scholar
  59. van Dam, H. A., van der Horst, F. G., Knoops, L., Ryckman, R. M., Crebolder, H. F., & van den Borne, B. H. (2005). Social support in diabetes: A systematic review of controlled intervention studies. Patient Education and Counseling, 59, 1–12. doi:10.1016/j.pec.2004.11.001.PubMedCrossRefGoogle Scholar
  60. Watkins, K. W., Connell, C. M., Fitzgerald, J. T., Klem, L., Hickey, T., & Ingersoll-Dayton, B. (2000). Effect of adults’ self-regulation of diabetes on quality-of-life outcomes. Diabetes Care, 23(10), 1511–1515. doi:10.2337/diacare.23.10.1511.PubMedCrossRefGoogle Scholar
  61. Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress, and distress: Exploring the central role of negative affectivity. Psychological Bulletin, 96, 234–254.Google Scholar
  62. Weinberger, M., Kirkman, M. S., Samsa, G. P., Shortliffe, E. A., Landsman, P. B., Cowper, P. A., et al. (1995). A nurse-coordinated intervention for primary care patients with non-insulin-dependent diabetes mellitus: Impact on glycemic control and health-related quality of life. Journal of General Internal Medicine, 10(2), 59–66. doi:10.1007/BF02600227.PubMedCrossRefGoogle Scholar
  63. Whitlock, W. L., Brown, A., Moore, K., Pavliscsak, H., Dingbaum, A., Lacefield, D., et al. (2000). Telemedicine improved diabetic management. Military Medicine, 165(8), 579–584.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • William P. Sacco
    • 1
  • John I. Malone
    • 1
  • Anthony D. Morrison
    • 1
  • Andrea Friedman
    • 1
  • Kristen Wells
    • 1
  1. 1.Department of PsychologyUniversity of South FloridaTampaUSA

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