Peer Support for Type 2 Diabetes

Summary

Peer Support for Type 2 Diabetes is primary care and VCSE partnership, between The Peer Partnership* and Sirona Care & Health, providing one-to-one peer support for people living with type 2 diabetes (PLWT2D).

In 2018, Bristol Community Health commissioned The Peer Partnership (an extension of Bristowe, a Bristol-based not-for-profit organisation, supporting people with long-term conditions) to translate their existing HIV peer mentoring service into the design, development and delivery of a service for PLWT2D. The service would train up to 20 volunteer mentors living with type 2 diabetes to provide community-based peer support for up to 40 patients a year.

The project was largely reported as a positive experience for all involved and, what started as a one-year pilot commissioned by Bristol Community Health for PLWT2D in Bristol, has since been recommissioned by Sirona Care & Health and expanded to cover the whole Bristol North Somerset South Gloucestershire Clinical Commissioning Group (BNSSG CCG) footprint.

The Peer Partnership has since extended its relationship with Sirona Care & Health to implement group peer support services to people living with long Covid in February 2022, as well as actively discussing other conditions in which peer support could be a desirable intervention.

The challenge

The project looks at ways of working with PLWT2D who have been advised by medical professionals on lifestyle changes, but who have real or perceived barriers in following this advice. The purpose of the project is to increase the knowledge, confidence, and ability of people to self-manage their condition in the community, with a helping start provided by mentors living with the condition themselves. The purpose for Bristol Community Health was to enhance the quality of life of patients and have a positive experience of care following diagnosis or periods of poor condition management.

The approach

The mentoring is designed to increase patient knowledge, confidence, and ability to self-manage, through the sharing of lived experiences, information and goal setting and reviewing. The mentors (Peer Support Mentor Volunteers) are trained by The Peer Partnership in mentoring, motivational interviewing, goal setting, action planning, boundaries, confidentiality and safeguarding. Once trained they are then matched with PLWT2D who feel they need support in managing their condition. Mentors and mentees meet on average once a week for an hour to discuss issues, share experiences, develop goals, and review actions related to their specific diabetes situation and the life circumstances around it. The peer interventions take place in cafes, community centres and other public spaces in the region.

During the pilot, the service was evaluated using Patient Activation Measures (PAMS) which, when increased, led to:

  • reduced hospital admissions
  • reduced medical errors
  • better coordination between health care providers
  • less negative health consequences due to miscommunication
  • greater levels of confidence in health care provision

Impact was also measured anecdotally through the collection of participant case studies.

The impact

The primary outcome of the project was a significant increase in Patient Activation Measures (PAMS): initial baselines measured an average score of 2 out of 4. Following the intervention, this average score increased to 4 out of 4.

The feedback from mentees was exceptionally positive, even from those who were initially skeptical about its potential to help them:

“I just want to let you know that with the regular guidance from my mentor, I have not only managed to lose weight, but have heard from my surgery that I have managed to get my blood sugar down below the threshold for diabetes! I am so thrilled. I consider my mentor to have been the key person who has enabled this to happen. So, I just wanted to say that having started out a sceptic, I really think diabetes mentoring works and really hope you can extend this support to other people in future.”

Mentee, 2020

The data and anecdotally evidenced outcomes have continued through several recommissions of the project. Satisfaction of those who received support from this service was so positive that many applied to become the next generation of peer mentors within the service. 30% of mentors were first introduced to the project as mentees.

As well as the impact of peer support on mentees, the project also saw significant benefits for the trained Peer Support Mentor Volunteers. The mentors had increased confidence in their own condition management and felt affirmed and validated for their own journey to managing their type 2 diabetes, and being trusted to provide support for others:

“I love being a peer mentor, it gives me so much pleasure to help other people in the same situation as me and to get a grip with their condition. I learned a lot from my mentees and my fellow mentors but by mentoring it also helps me be focused and gives me strength to continue to manage my T2 diabetes.”

Mentor 2021

Key learnings

Positive elements that helped the service to thrive included:

  • Supportive clinical staff who recognised the potential for this service to support their offerings to patients, and were willing to put significant time into the early stages of building the project and maintaining strong relations with the VCSE partner.
  • Provision by the primary healthcare provider of access to the VCSE partner to contacts and services that could support the services development, including links to primary care trusts, type 2 diabetes structured education sessions, diabetes conferences, and other VCSE partners.
  • A recognition of the skills and responsibilities held within each organisation partner.
  • Forming a project advisory group who meet regularly & made up of key members who are involved in delivering the project.

 

Learnings for future improvements included:

  • The need for greater patient involvement at the design stage of the project’s development, including focus groups for format, venues and point of access, and regular follow-up groups to allow for ongoing service improvements.
  • A recognition of different language/terminology used in the VSCE and NHS as well as the different processes. Time/capacity is needed to explain these to ensure all project partners can both understand and relate to each other, and encourage even balance within the relationship.
  • The need for regular meetings at senior management level to allow for decisive actions on development.
  • The need for contracts clearly outlining terms of service and agreements on timescales for evaluation and recommissioning of services from both sides to allow for long term-organisational planning.
  • Clear role and responsibility outlines of each organization. Individual staff to potentially have a role description outlining their role/responsibility to prevent confusion/misunderstanding.
  • The need to carefully consider referral routes, and have contingency plans to ensure momentum of services is not lost.
  • The need for effective information sharing policies and procedures to allow for direct patient information transfer in line with confidentiality and GDPR data processing guidelines.

Next steps

The program has continued for over two years beyond its original pilot project and was recommissioned by Sirona Care & Health when it took ownership of the primary care contract with BNSSG CCG. Although the program has been on year-long fixed term contracts, discussions are ongoing to make this a permanent project.

In addition to this project, The Peer Partnership has extended its relationship with Sirona Care & Health to implement group peer support services for people living with long Covid in February 2022, as well as actively discussing other conditions in which peer support could be a desirable intervention.

Find out more

Read the detailed report of the Peer Support for Type 2 Diabetes pilot project here.

More information about The Peer Partnership can be found here.

* The Peer Partnership is a fully owned brand of Brigstowe. All references to The Peer Partnership relate to a change of branding for all of Brigstowe’s non-HIV work in 2020.

More information on Brigstowe can be found here.

Contact details

For general enquiries email info@peerpartnership.org or call 0117 9555038.

For Diabetes Peer Support Enquiries email Peer Support Coordinator Denise Wain at Deniseswain@peerpartnership.org

For Professional Peer Support Services Enquiries, email Development and Training Coordinator Sean Hourigan at seanhourigan@peerpartnership.org

 

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