Older Adults Using Social Support to Improve Self-Care (OASIS): Adaption, Implementation, and Feasibility of Peer Support for Older Adults with T2DM in Appalachia

ABSTRACT Approximately 34.1 million (13%) adults in the US have type 2 diabetes (T2D). The prevalence of T2D is 17% higher in rural dwellers compared to their urban counterparts, and the prevalence of T2D increases with age, with an estimated 25% of older adults (≥ 65 years) diagnosed. Appropriate self-care is necessary for optimal clinical outcomes, and variability in self-care accounts for 90% of the variance in glycemic control. Overall, T2D self-care is consistently poor among the general population but is even worse in rural-dwellers and older adults. This is particularly true in rural Kentucky, where up to 23% of adults in Appalachian communities have been diagnosed with T2D and, of those, 26.8% are older adults. To attain optimal clinical outcomes, social environmental factors, including social support, are integral when promoting T2D self-care. Specifically, peer support has shown to be efficacious in improving T2D self-care behaviors; it provides emotional support, instrumental support, and education while also helping individuals develop new skills. Similarly, peer support has also been shown to improve clinical and psychosocial outcomes related to T2D; however, there is literature that also suggests self-selected social support can be obstructive when trying to engage in healthful activities. Currently available evidence-based interventions (EBIs) using peer support have not been used specifically to prioritize older adults, especially those living in rural communities. To address this gap in research, we have conducted formative research with regional practitioners, leaders of service organizations in Appalachia, and residents, and through that process, we collaboratively identified an acceptable and feasible peer support EBI—peer health coaching (PHC)—that has resulted in improved clinical and psychosocial T2D-related outcomes among participants who did not reside in rural communities nor were ≥65 years. Through these community conversations, we also determined necessary a priori adaptations to the EBI to ensure its cultural and contextual relevance to regional needs and values. Because PHC is a community-based and low-cost intervention, it holds promise to be a sustainable and scalable model across Appalachian Kentucky where resources are often scant, but community bonds are valued. Informed by literature and feedback from stakeholders, the goal of the proposed study is to use a 2x2 factorial design to test the adapted PHC components and determine their preliminary effectiveness to promote self-care behaviors and improve glycemic control among older adults living in Appalachian Kentucky. The main components of the factorial design will be how peer coaches are selected for participants (self-selected vs matched) and frequency of contact with coach (once per week vs every 2 weeks). To achieve this goal, we will (1) determine which EBI components are associated with improved T2D- related outcomes in older adults living in Appalachia Kentucky and (2) evaluate the pragmatic implementability of the adapted EBI.