Patient Engagement and Coaching for Health (PEACH)

1
Patient Engagement and Coaching for Health (PEACH)

• An intensive treatment intervention for patients
  with type 2 diabetes in disadvantaged
  communities.
• Consumer consultation phase.
• Furler J, Walker C, Blackberry I, Hadj E and
  Young D

2
What is PEACH?

• A research project involving Practice Nurses
  in General Practice and the COACH technique to
  enable people to manage their type 2 diabetes
  more effectively

3
Overview of PEACH

• Consumer consultation phase (Qualitative)
• Cluster Randomised controlled trial phase
  (Quantitative)
• Post-intervention workshop phase (Qualitative)

4
Objective

• To determine the patient level barriers and
  facilitators to implementing a program of
  telephone coaching for type 2 diabetes in a
  General Practice setting in a disadvantaged
  community

5
Methods (1)

• Flyers in English, Turkish and Arabic distributed
  to invite people with type 2 diabetes who reside
  in the Hume Moreland region of Melbournes North
  West
• 2 English speaking groups (13 and 11 type 2
  diabetes participants), 1 Turkish speaking group
  (12 participants) and 1 Arabic speaking group
  (18 participants)
• Consent form/ethics
• Interpreter

6
Methods (2)

• Two groups with English speaking patients
  explored the impact of diabetes on their life,
  their perceptions of the role self management,
  the role of social support and its relationship
  to accessing health care, and the barriers and
  enablers to participating and remaining in the
  telephone coaching program.
• Focus groups with Arabic and Turkish speaking
  patients explored important cultural factors in
  self-management and telephone coaching.

7
Finding from English speaking groups and its
implication

• Diversity of English skills
• Dominance of emotional issues
• Resentment and anxiety at the diagnosis
• Diet (negative) and exercise (positive)
  emotionally laden
• Importance of family support
• Relationship with health professionals
• Importance of Community Health Services
• Poor understanding of diabetes monitoring

• Interpreter budget
• Explore capacity of COACH technique to engage
  with these issues
• Need to explore individual views
• Need to ascertain dominant relationship
• Linking patients to other services in the area
  within COACH
• Need to explore individual level of understanding

8
Finding from Turkish and Arabic groups and its
implication

• Congruence with COACH
• Poor understanding on the role of telephone
  coaching
• Concern over substitute for GP services
• Confusion with other diabetes programs
• GP central to care
• Greater commitment to medication and less focus
  on self management through diet and exercise
• Dominant role of stress

• Clarification as an element of COACH
• Need to clarify coach program focus
• Recruitment needs strong GP endorsement
• Need continuing coach role reinforcement
• COACH needs to explore individual beliefs in
  relation to self-management

9
Discussion

• Focus groups suggest that emotional issues and
  family relationships are significant factors in
  adopting self-care behaviours.
• These issues may pose greater barriers than
  lower SES and residing in areas of greater
  disadvantage.

10
Implications for policy, delivery or practice

• We will incorporate our findings in the COACH
  program
• Coaching patients to play a more active role in
  expecting intensive structured care seems
  congruent with the wishes of patients.
• Priming GPs to be receptive to this may be
  important.

11
Patient Engagement and Coaching for Health (PEACH)

• Dr Irene Blackberry
• PEACH study coordinator
• Dept of GP, The University of Melbourne
• 200 Berkeley St, Carlton VIC 3053
• Email i.blackberry_at_unimelb.edu.au
• www.peach.unimelb.edu.au