Building Competency in Diabetes Education THE ESSENTIALS

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helping patients maintain/improve their glycemic control, decrease feelings of isolation, decrease depressive symptoms and in helping to deal with diabetes-related anxiety (123). Studies have looked at several different models of peer support, including: • Face-to-face groups. • Coaching and mentors.

• Community health workers. • Telephone-based support. • Use of Internet, email and technology (111).

Several of the programs mentioned below are using peer supporters to deliver SMS.

Chronic Disease Self-Management Program One of the most widespread support programs being offered is the Chronic Disease Self Management Program (CDSMP) developed by Lorig et al. (95,124). Initially, this program was conducted in a face-to-face group setting, but, more recently, it has proven to be effective in an online version. CDSMP is a peer-led program geared at enhancing self-efficacy for self-care (124-126). The focus is on the acquisition of problem-solving and coping skills considered essential to living well with any chronic illness (95). The original program was developed to be generic (for people with diabetes, hypertension or arthritis), but has since been adapted for disease-specific (diabetes or arthritis) entities (127). There is some evidence that these programs have proven to be helpful in several domains and also cost-effective (38,125,128). Improved health behaviour outcomes, self-efficacy and health status have been reported with small statistical significance (129), but health-care utilization has not been significantly modified by these programs (125,128,130,131). A recent meta-analysis looking at CDSM programs around the world concluded that these programs showed small to moderate improvement in psychological health and in other select health behaviours, and these effects were sustained over the year following the program (131). To date, the evidence suggests that CDSM programs are a valuable adjunct in developing the tools and confidence to engage in positive self-management behaviours (131). Further research may help us determine the full impact of these programs on health outcomes and who will benefit to the greatest extent from this type of support intervention (13,96,129).