Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. The lipid requirements for the present study represent relatively low thresholds. For example, approximately half of all adults have cholesterol levels above 200.

  2. The number of participants completing the social support (n = 31) and reinforcement received (n = 28) was lower than the study N because initial versions of these measures did not adequately direct participants to reflect on support and reinforcement received from their healthcare team. Only responses to the corrected versions were included in analyses of these variables.

References

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Bandura, A. (1998). Health promotion from the perspective of social-cognitive theory. Psychology & Health, 13, 623–649. doi:10.1080/08870449808407422.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Brown, S. A. (1990). Studies of educational interventions and outcomes in diabetic adults: A meta-analysis revisited. Patient Education & Counseling, 16(3), 189–215.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Mensing, C., et al. (2002). National standards for diabetes self-management education. Diabetes Care, 25S, S140–S147. doi:10.2337/diacare.25.2007.S140.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Thomas, D. E., Elliott, E. J., & Naughton, G. A. (2006). Exercise for type 2 diabetes mellitus. The Cochrane Database of Systematic Reviews, 3, CD002968.

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported, in part, by an Award from the American Heart Association. The authors acknowledge the following individuals who served as coaches for this study: Amanda Magee, Laura Cardona, Rebecca Mathew, Barbara Houser, Kristin Phillips, Patricia Steiner, Claudia Gerard, Ariz Rojas, Antoniette Maldonado, Nicole Bower, and Tenille Valdivia.

Author information

Authors and Affiliations

  1. Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118-G, Tampa, FL, 33620, USA

    William P. Sacco, John I. Malone, Anthony D. Morrison, Andrea Friedman & Kristen Wells

Authors
  1. William P. Sacco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John I. Malone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anthony D. Morrison
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea Friedman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kristen Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William P. Sacco.

Additional information

Preliminary results from this study were previously presented (Friedman et al. 2003).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sacco, W.P., Malone, J.I., Morrison, A.D. et al. Effect of a brief, regular telephone intervention by paraprofessionals for type 2 diabetes. J Behav Med 32, 349–359 (2009). https://doi.org/10.1007/s10865-009-9209-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-009-9209-4

Keywords

Search

Navigation