Diabetes Self-Management Articles

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Peer Support, Education, and Mentoring

by Martha Mitchell Funnell, MS, RN, CDE

Peer mentoring generally refers to two people working together who both have diabetes, but one is designated the mentor, or role model. A person may be designated a mentor for several reasons: That person may have had diabetes longer, successfully implemented a therapy such as insulin, or been able to lose weight or bring his A1C and other measures into the target range. The mentor offers ideas and suggestions to his peer based on his own experiences and what worked for him. There are also programs that identify mentors, or “champions,” who give inspirational talks to individuals or groups of people with diabetes. Some people like the idea of working with a mentor, while others prefer to be on a more equal level, where they can offer support as well as receive help.

Peer education generally refers to diabetes education provided by a person other than a health-care professional. Peer educators often work with a health professional who is a diabetes educator or through a health-care clinic. They generally receive training in the care of diabetes and in how to be an effective teacher.

Some peer educators are community health workers, or promotores, who may or may not have diabetes. However, they are considered peers because they have close ties with the community; they may speak the language, for example, or be from the same cultural or ethnic group. They often serve as a guide for information and for making lifestyle changes, and they bridge the cultural gap between the person with diabetes and his health-care providers. Community health workers are also generally very knowledgeable about local resources and services. Most community health workers receive on-the-job training that targets the objectives of the program they’re working for. Some institutes of higher education have also started offering formalized community health worker education programs that offer credit, a certificate, or a degree.

Peer-led self-management support groups generally refer to formal group programs designed to help people learn the skills needed to make lifestyle and other behavioral changes and to also provide the support needed to better cope with diabetes. These are different from the usual support group in that the peer leaders have been trained to facilitate groups, teach behavioral strategies, and provide support. There are peer-led self-management support programs available for people with any chronic disease, including diabetes, and programs that are specifically for people with diabetes.

All of these types of formal programs have been studied and shown to be effective in helping people better manage their diabetes. The types of improvements that have been reported include such outcomes such as lower A1C, improved quality of life, increased health behaviors such as eating healthfully and taking medicines, and even decreased hospitalizations. Some of the other benefits are increased confidence in ability to manage diabetes (called self-efficacy), social support, positive mood, and understanding of diabetes self-management. Because each of these types of programs is different, you are the best judge of what type might be most helpful for you.

Finding a peer support program
Although peer programs are gaining in popularity, they are not yet everywhere. So the first step is to find out what is available in your area. Your local hospital education program, health department, or diabetes organization is often a good place to begin.

The second step is to decide if you want educational support or support for changing your behavior and coping with diabetes, or a program that has both. You also need to decide if you want to work as an equal partner, be a mentor, or have a mentor. Some programs provide options for all of these, but it helps to know what you need and want. Here is a sampling of some available programs.

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