Sample
This pre-post single group study tested the feasibility and acceptability of the 16-week peer educator training component of the HOPE intervention. The study was approved by the University Social Sciences Human Subjects Protection Committee and participants provided written informed consent prior to any study procedure.
Any woman who self-identified as African American was eligible to participate in the training program if she was 40 years of age or older and identified as the primary caregiver of one or more grandchildren ages 2 through 18 years. A primary caregiver was defined as “one who provides instrumental and expressive care to a grandchild living in the same household daily for an indefinite period.” [29] In addition, women interested in becoming a peer educator had to meet eligibility requirements for participating in DPP which included: (1) being overweight or obese (BMI ≥ 25 kg/m2); (2) no previous diagnosis of diabetes; 3) and a glycosylated hemoglobin A1C between 5.7 and 6.4% [19]. The grandmother must be willing to complete a demographic questionnaire and two validated surveys that assess physical activity and dietary behavior.
The grandmother must be willing to be weighed at the time of enrollment in the study and the end of the study period as well as attend weekly DPP training sessions as able. Grandmothers were excluded if they were pregnant or had diseases that would limit their life span or restrict their ability to participate in the study.
We recruited 30 women from two community centers located in ethnically diverse neighborhoods in Wisconsin. The staff at each community center was asked to identify 15 women whom they felt would be a good peer educator for the HOPE peer educator training. In addition to meeting the inclusion criteria listed above for grandmothers, desirable characteristics and attributes of a peer educator included being actively engaged in community-based activities, being willing and available to be trained and participate in the subsequent DPP + HOPE intervention, have good interpersonal skills, possess similarities to the target participants, be respected in the community, have the ability to motivate others, have good listening skills, have basic problem-solving skills, live in the community being served, and be willing to help the community.
Peer support training
The grandmothers were required to participate in a 32-h DPP training program. The training program’s schedule is flexible. The training program can be offered in its entirety on 4 consecutive days for trainees who prefer a concentrated experience or spread out over a 2-to-16-week period. The HOPE training program was offered 2 h a week over 16 weeks to accommodate the participants schedules.
The sessions which were led by a diabetes care and education specialist, promoted healthy eating, increased physical activity, modest weight loss (5%), and reduction in hemoglobin A1C. The sessions also covered the role of the peer educator which included empathic listening and helping participants develop health goals for themselves and family members. These training sessions were guided by the DPP training manual and a peer support training manual and toolkit that focused on supportive, non-judgmental communication, goal setting, motivational interviewing, and providing social and emotional support. The grandmothers were also required to complete human participant research ethics (IRB) training.
Measures
We assessed the feasibility of the training program by noting the number of participants recruited and retained in the program. We also conducted open-ended interviews during the last week of the program to learn about each participant’s experience during the training sessions. The 30-min interview was led by a study team member who did not participate in the training sessions to encourage honest feedback. Based on our previous work [21], we asked participants to share their views regarding: (a) beneficial or useful aspects of the program; (b) problems or difficulties experienced during the program; (c) recommendations to improve the program; and (d) if they would recommend the program to a friend. The interviews were audio recorded and transcribed. Participants who dropped out of the program were interviewed by phone to learn (a) why they left the program, (b) aspect of the program they liked or disliked, and (c) recommendations for improving the program [21].
A digital electronic scale (Conair Body Analysis Weight Tracker Scale Model CON WW89T) was used to measure the body weight of each participant. Each grandmother’s weight was obtained while the woman was in a standing position, shoeless, and wearing light clothing. Physical activity and dietary behavior were assessed at the time of enrollment and the completion of the 16 week training period using two validated surveys: the International Physical Activity Questionnaire (IPAQ) [30] and the Food Frequency Questionnaire [31]. The IPAQ estimates levels and frequency of physical activity during the past 7 days, and the Food Frequency Questionnaire contains questions about customary intake of various food groups [30, 31].
Hemoglobin A1c was evaluated at baseline to determine eligibility to participate in the study [19] and the end of the study to determine if the participant progressed to diabetes. We used the A1cNow + system, the National Glycohemoglobin Standardization Program Certified, CLIA-waived, system that provides results using a finger stick test.
Analysis
The authors read the transcripts from each interview thoroughly to obtain an understanding of the data. Analysis of the interview transcripts used a conventional content analysis approach [32], where each transcript was coded by hand with notations to delineate a basic description for each idea. The principal investigator (first author) and the co-investigator (second author) coded independently, then met to discuss their impressions and reach consensus about the overall meaning of the content. Finally, the authors identified common themes that emerged from the content analysis.
Because the data was slightly skewed, the Wilcoxon Sign Rank Test was used to assess changes in body weight, physical activity and fruit and vegetable intake from baseline to week 16. All analyses were conducted using SAS (SAS Institute Inc, Cary NC).
