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Running head: INTEGRATIVE LITERATURE REVIEW 1

Integrative Literature Review

Maryum Abdul-Basir

Bon Secours Memorial College of Nursing

Dr. Turner

NUR 4122: Nursing Research

November 18, 2018

I pledge.
INTEGRATIVE LITERATURE REVIEW 2

Abstract

Purpose: The purpose of this integrative review is to examine the relationship influence between

peer support groups and the treatment regimen of diabetic patients.

Background: Type II diabetes is a worldwide epidemic that is continuing to rise. The increase in

the number of cases cause for the creation of more treatments and interventions to support

individuals with type II diabetes with self-management skills and behaviors. Peer support groups

have been shown to be a cost-effective way to maximize adherence to diabetes treatment regime.

Method: This is an integrative review by which research was collected from online databases.

The articles discussed are quantitative in nature and chosen based on specific criteria. The

information was used to determine the influence peer support groups have on diabetic patients’

adherence to their treatment regimen.

Limitations: The most significant limitation is the author’s inexperience in conducting an

integrative review, as well as the limited amount of research articles used.

Results and Findings: The evidence complied in this review support the notion that there is a

positive benefit in the relationship between adherence to treatment regimen and peer support

groups. Areas of improvement in the treatment regime include metabolic parameters and

reduction in the incidence of complications associated with type II diabetes.

Implications and Recommendations: Attendance of peer support groups increases diabetic

patients’ knowledge and ability to manage the disease. It is recommended that further research

be completed in the United States to evaluate the effectiveness of peer support groups on diabetic

patients.
INTEGRATIVE LITERATURE REVIEW 3

Integrative Literature Review

The purpose of this integrated review is to examine the relationship influence between

peer support groups and the treatment regimen of diabetic patients. Diabetes is worldwide

epidemic that affects 25.8 million people and is expected to continue rising, eventually affecting

as much as 25% of the population by 2030 (Sachmechi et al., 2013). An increase in the number

of cases of diabetes requires more treatment options to be available for patients to be able

manage the disease effectively without the risk of developing complications. Diabetes is one of

the most prevalent causes of premature death, loss of productivity, and disability among

individuals (Aziz, Riddell, Absetz, Brand, & Oldenburg, 2018). Teaching and educating patients

about the treatment regime is an important factor in long-term maintenance. The treatment

regimen for the management of diabetes includes strict glycemic control, dietary control,

physical activity, and strict adherence to prescribed medications (Sachmechi et al., 2013).

Peer support groups allow for diabetic patients to improve their quality of life by

reducing risks of complications and improving self-management activities. Groups comprised of

peers can help diabetic patients with adapting healthy behaviors due to increased knowledge and

feelings of social connectiveness (Aziz et al., 2018). Along with diabetes education, peer

support groups can be a beneficial cost-effective method to maintain self-management care of

diabetic patients. The aim of this review is to assess and discuss published data related to the

researcher’s PICO question: In patients with type II diabetes, does attending peer support groups

influence compliance with prescribed treatment regimen?

Design/ Search Methods

The research design for this paper is an integrative review. The search for articles was

completed using the computer-based search engine databases EBSCO Discovery Services and
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Academic Search Complete. The search words used to conduct the search were diabetes, support

group, peer intervention, peer group, and education. The results yielded over 700 articles from

EBSCO Discovery Services and 256 articles from Academic Search Complete. Using a

combination of the various search words created even more results from both databases. In order

to filter the results to a narrower span, the articles were filtered by year, peer-reviewed, language,

and relevance to the researcher’s PICO question. In order to maintain relevance of current

literature, only articles that were published between the years of 2013-2018 were

included in the search. The search was also limited to peer-reviewed qualitative or quantitative

articles, and full-text availability was also a filter used to limit results.

The process for inclusion of articles included prioritizing articles in regard to their

relevance to the researcher’s PICO question, as well as including peer support interventions that

focused specifically on type II diabetes. The researcher used quantitative studies to find research

on the topic. The authors of the articles were qualified to conduct these studies based on having

similar qualifications: Medical Doctor (MD), Doctor of Philosophy (PhD), and Master of Public

Heath (MPH). The five articles that were chosen, after filtering out limitations, resulted in five

quantitative studies (Aziz et al., 2018; Ing et al., 2016; Johansson, Keller, Sönnichsen, &

Weitgasser, 2017; Peimani, Monjazebi, Ghodssi-Ghassemadabi, & Nasli-Esfahani, 2018;

Sachmechi et al., 2013).

Findings and Results

The results and findings of each study provide evidence that supports the relationship

between diabetes peer support groups and improved self-management of the disease by diabetic

patients. Each article offered different variables being measured such as metabolic parameters,

self-care behaviors, impact on complications (length of hospital stays, number of


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hospitalizations, number of prescription drugs), and social support. The results and findings of

the articles clearly identified a positive association between the influence of peer support groups

and an increase in patients with diabetes self-management behaviors (Aziz et al, 2018, Ing, et al.,

2016; Johansson et al., 2017; Peimani et al., 2018; Sachmechi et al., 2013). The similar themes

and findings of each article support the PICO question being researched and the results of the

literature review are presented below.

Glycemic Control and Metabolic Parameters

A quantitative, quasi-experimental study design was conducted by Sachmechi et al.

(2013), to investigate the effects of diabetes education alone versus diabetes education plus peer

support groups on improving metabolic parameters in patients which diabetes. The authors of the

study intended to measure the effectiveness of the social support groups to existing diabetes

education on metabolic parameters in patients with diabetes. The study methods for this

experiment included a comparison between baseline measurements and post-implementation

measurements. The changes from mean baseline to the third month, sixth month and final follow

up period were calculated. Major variables for metabolic parameters included the following:

hemoglobin a1C, weight, body mass index, systolic blood pressure, total cholesterol, high-

density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), and triglycerides (TG-C). Data

was collected from a review of medical records with appropriate lab findings at eight months

(control group), 13 months (diabetes education group) and 19 months (diabetes education and

peer support group) after the interventions were initiated. The sample size of the study included

188 total participants who receive care from the Diabetes Centre and Primary Care Clinics in

Queens Hospital in New York. The participants were divided into three groups: 62 participants

were in the control group, 63 participants were in diabetes education group, and 63 participants
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were in the diabetes education and peer support group. Data was analyzed using Minitab version

14 to determine the mean change from the baseline of lab values for the specific metabolic

parameters. The findings of the study found that participation in diabetes education showed a

significant decrease in mean HbA1C levels, TC and LDL-C levels. Participation in diabetes

education and peer support groups can lead to a decrease in HbA1C, systolic blood pressure, and

TG-C (Sachmechi et al., 2013).

A study conducted by Ing et al. (2016), looked to examine how diabetes-specific social

support groups, along with a diabetes self-management education intervention, improve

glycemic control and self-care behaviors in patients with type two diabetes. The goal is to

measure whether the addition of social support groups to a diabetes self-management education

intervention would be beneficial as a component to maintenance of improvements. This quasi-

experimental design used pre-implementation and post-implementation. The two major variables

that were studied were the social support group versus the control group. The sample size

included 65 participants who were diagnosed with type two diabetes, and they were chosen from

local communities. Baseline assessments were completed, and the Partners in Care intervention

was done. At the three-month assessment, 47 participants were randomly chosen to participate in

six support group meetings. Out of the 47 participants, 25 were placed in the intervention group

and remaining participants were placed in the control group and given standard follow-up. At the

six-month assessment, participants were assessed using surveys, as well as finger stick blood

samples to test measurements for metabolic parameters as compared to baseline results. The

measurement tool and data collection method for the study included fingerstick samples of blood

taken at baseline, the three-month mark, and the six-month mark. Also, a survey consisting of 12

items with a Likert-type response measuring the understanding of diabetes self-care activities
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was completed. Statistical data analysis was done using ANCOVA and compared results

between mean baseline measurements and participants mean responses to surveys. The results of

the study found improvements to HbA1C, diabetes-related self-management knowledge, and

behaviors improved from baseline to the three-month assessment (Ing et al., 2016). The social

support group had more of a significant decrease in systolic blood pressure at the three-month

and six-month assessment compared to the control group.

A study conducted by Peimani et al., (2018), looked to assess the effectiveness of peer

support as it pertains to improving self-care behaviors, self-efficacy, and quality of life in

patients with type II diabetes. The study was a quantitative randomized control experiment that

looked at variables including self-care behaviors, self-efficacy beliefs, clinical outcomes (Ha1c

and body mass index), and quality of life. Pre-implementation and post-implementation

comparison were used in the research design method. The sample size for the study included 200

participants; 100 were in the control group, which received basic education from a diabetes

educator, while the other 100 participants were in the peer lead support group. The interventions

consisted of weekly meetings over a six-month time frame. Descriptive statistics were used to

summarize the characteristics, frequencies, and percentages for the sample data collected from

the questionnaires completed by participants. The Chi-squared test was used to analyze and

compare data between the two groups (control and intervention group). The results of the study

found that there was a significant decrease in the mean Ha1C value in the intervention group

compared to the control group (Peimani et al., 2018). There was also an increase in the mean

score in the quality of life category. The authors of the study recommended that further research

needs to be conducted that will implement, design, and evaluate different models of peer support

to meet the needs of different populations (Peimani et al., 2018).


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Complications of Diabetes

A post-hoc controlled study based on a secondary data analysis of a 24-month

randomized control intervention trial was conducted by Johansson et al. (2017). This study

looked to explore whether implementing group-based peer support as an additional component to

disease management program (DMP) in type II diabetes can reduce the number of prescribed

drugs, hospital admissions, and length of hospital stay. The researchers wanted to examine a

method that will decrease the occurrence of complications due to diabetes mismanagement. The

sample size for the study included 148 people (19 groups) receiving the intervention and 189 (20

groups) in the control group. Data and outcome measures were collected via the costs database,

Folgekosten Datenbank, through health insurance records. Data was analyzed using SPSS

Statistics 20.0. A descriptive and effectiveness analysis was performed based on the FOKO-data.

The Mann-Whitney U test was used on non-normal distributions to detect the differences

between the groups. The results of the study found that providing peer support programs to

strengthen lifestyle interventions for individuals diagnosed with type II diabetes can be a cost-

effective model (Johansson et al., 2017). Peer support can also be beneficial in shorter hospital

stays, which can ultimately decrease health care costs and allow for more funds to be allocated to

support more research on the benefits of peer support to improve patient compliance with their

treatment regimen (Johansson et al., 2017).

An experimental randomized control trial conducted by Aziz et al. (2018), sought to

evaluate the implementation of a Peers for Progress Diabetes Program (Pfp-Dp) in Australia

using the Glasgow’s Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-

AIM) and Pronk’s Penetration, Implementation, Participation, and Effectiveness (PIPE)

theoretical frameworks. The participants attended monthly group meetings, facilitated by a


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trained peer leader, for 12 months. Data was collected via surveys on the interventions’ reach,

participation, implementation fidelity, groups’ effectiveness, participants’ perceived support, and

satisfaction with the intervention. The participants had clinical blood testing done including

HbA1c, cholesterol, and LDL: HDL ratio, which were drawn at baseline, six-months, and at the

12-month follow-up. The participants completed an evaluation questionnaire of the program at

the conclusion of the 12-month intervention. The sample size consisted of 24 support groups,

with a total of 273 participants. A descriptive analysis using SPSS was used to calculate a

coefficient for each component of the framework evaluation tool. The findings of the study

show that group-based peer support programs positively impact individuals with type II diabetes

in improving their diabetes control (Aziz et al., 2018). Like the authors of the study by Peimani

et al. (2018), the authors of this study recommend that there is a need for more research to bring

more structured and effective peer support programs to individuals diagnosed with type II

diabetes.

Discussion and Implications

The articles selected for the review indicate a positive effect of peer support groups in

multiple areas of the treatment regimen of a diabetic patient (Aziz et al., 2018; Ing et al., 2016;

Johansson, Keller, Sönnichsen, & Weitgasser, 2017; Peimani, Monjazebi, Ghodssi-

Ghassemadabi, & Nasli-Esfahani, 2018; Sachmechi et al., 2013). All of the articles found for the

review were research studies conducted abroad, which indicate a need for further research to be

conducted in the United States. This notion was further supported by recommendations made by

the authors of the research articles for the creation and integration of more peer support

interventions for diabetic patients (Aziz et al., 2018; Peimani et al., 2018). The researcher framed
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the review according to the following categories: glycemic control/metabolic parameters and

complications due to diabetes. The following is a discussion on the implications of the articles.

Glycemic Control/Metabolic Parameters

Maintaining glycemic control and metabolic parameters including blood pressure,

weight, cholesterol, HDL, LDL, and triglycerides are key factors in self-managing diabetes. By

optimizing these parameters, this could lead to a reduction in diabetes-related deaths and

cardiovascular complications by 21% (Sachmechi et al., 2013). Many of the metabolic

parameters mentioned in the context of the articles are risk factors for many diabetic

complications such as cardiovascular disease, stroke, and diabetic neuropathy (Peimani et al.,

2018). Teaching the importance of glycemic control on health outcomes is an important aspect of

diabetes education. Peer support groups should be integrated into education on the parameters of

glycemic control to help meet the minimum needs of diabetic patients (Peimani et al., 2018).

Complications

Preventing complications from diabetes and preserving quality of life for diabetes

patients is the main goal in the treatment plan. Uncontrolled diabetes can lead to an increase in

hospital admissions, longer hospital length-of-stays, and an increase in the number of

prescription medications (Johansson et al., 2017). Due to the rise in healthcare costs associated

with complications, there is a need for a cost-effective model, such as peer support groups, that

can enhance the quality of life for diabetes patients (Aziz et al., 2018). A peer support group, as

an additional component to diabetes disease management, was shown to reduce the cost

associated with hospital length-of-stays in research participants by $2,651.70 per hospital stay

(Johansson et al., 2017). Complications from diabetes impede on patients’ self-management

behaviors, which results in treatment regimens being followed inappropriately.


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Limitations

In conducting this integrative review, there were many limitations that the researcher

encountered. One of the major limitations to this review is the researcher’s inexperience and lack

of knowledge about the process of an integrative review. This review was completed as a class

assignment for a research course. The researcher has few qualifications for providing a reliable,

discussion of the subject that is being studied. Another limitation is that the review only

consisted of five research articles that were limited to a five-year publication date. The sample

sizes of the research studies were a limitation because none of the articles stated the use of a

power analysis to determine whether the sample size was adequate for the type of quantitative

research that was performed. Also, the articles chosen for this review did not include a validity or

reliability of measurement tool, which is another limitation to the strength of the research.

Conclusion

The evidence complied for this integrative review supports the idea that peer support

groups have a positive influence on compliance of treatment regime in patients with type II

diabetes (Aziz et al, 2018, Ing, et al., 2016; Johansson et al., 2017; Peimani et al., 2018;

Sachmechi et al., 2013). Peer support groups provide a cost-effective way to provide

supplemental treatment that supports long-term self-management care of diabetes. Reducing

complications, improving glycemic control/metabolic parameters, and improving quality of life

are all factors incorporated in the treatment of diabetes. In relation to the PICO question being

addressed, “In patients with type II diabetes, does attending peer support groups influence

compliance with prescribed treatment regime?”, the literature reflects a benefit to the

incorporation of peer support groups and their influence on the compliance of diabetic patients’

treatment regimen.
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References

Aziz, Z., Riddell, M. A., Absetz, P., Brand, M & Oldenburg, B. (2018). Peer support to improve

diabetes care: An implementation evaluation of the Australasian peers for progress

diabetes program. BMC Public Health, 18(1), 1-12. doi:10.1186/s12889-018-5148-8

Ing, C. T., Zhang, G., Dillard, A., Yoshimura, S. R., Hughes, C., Palakiko, D.-M.,

Kaholokula, J. K. (2016). Social support groups in the maintenance of glycemic control

after community-based intervention. Journal of Diabetes Research, 1–8.

doi:10.1155/2016/7913258

Johansson, T., Keller, S., Sönnichsen, A. C., & Weitgasser, R. (2017). Cost analysis of a peer

support programme for patients with type 2 diabetes: A secondary analysis of a

controlled trial. European Journal of Public Health, 27(2), 256–261.

doi:10.1093/eurpub/ckw158

Peimani, M., Monjazebi, F., Ghodssi-Ghassemadabi, R., & Nasli-Esfahani, E. (2018). A peer

support intervention in improving glycemic control in patients with type 2

diabetes. Patient Education & Counseling. 101(3), 460–466.

doi:10.1016/j.pec.2017.10.007

Sachmechi, I., Wang, A., Kim, P., Reich, D., Payne, H., & Salvador, V. B. (2013). Impact of

diabetes education and peer support group on the metabolic parameters of patients with

Diabetes Mellitus (Type 1 and Type 2). British Journal of Medical Practitioners, 6(4),

37–41. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=a9h&AN=

94986227&site=eds-live
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Appendix

APA Citation for Sachmechi, I., Wang, A., Kim, P., Reich, D., Payne, H., & Salvador, V. B. (2013). Impact of diabetes
Article education and peer support group on the metabolic parameters of patients with Diabetes Mellitus (Type 1
and Type 2). British Journal of Medical Practitioners, 6(4), 37–41. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,athens&db=a9h&AN=94986227&site=
eds-live

Author(s) - Authors Sachmechi, (2013) Wang, (2013), Kim (2013), Reich (2013), and Salvador (2013) are all Medical
Qualifications Doctors working for the Icahn School of Medicine in Queens, NY. Author Payne (2013) is a Registered
Nurse with the Diabetics Clinic in Queens, NY.
Background/Problem The study was designed to investigate the effects of diabetes education versus diabetes education plus peer
Statement support groups on improving metabolic parameters in patients which diabetes. The authors of the study
intended to measure the effectiveness of the social support groups to existing diabetes education on
metabolic parameters in patients with diabetes.

Conceptual/theoretic The authors of the study failed to mention the use of a theoretical or conceptual framework used
al Framework

Design/Method Quantitative quasi-experimental between baseline measurements and postimplementation comparison.


If appropriate, The changes from mean baseline to the third month, sixth month and final follow up period were
Philosophical calculated.
Underpinnings

Sample/  188 total participants who receive care from the Diabetes Centre and Primary Care Clinics in
Setting/Ethical Queens Hospital in New York divided into three groups
Considerations  62 participants in control group, 63 participants in diabetes education group, 63 participants in
Diabetes education and peer support group
 Obtained informed consent, excluded names from research materials.
Major Variables Metabolic parameters including the following:
Studied (and their  Hemoglobin A1C
definition), if  Weight body mass index
appropriate  Systolic blood pressure
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 Total cholesterol
 High-density lipoprotein HDL-C
 Low-density lipoprotein LDL-C
 Triglycerides TG-C
Measurement
Tool/Data Collection Review of medical records with appropriate lab findings 8 months (control group), 13 months (Diabetes
Method Education group) and 19 months (Diabetes Education and Peer Support group) after intervention was
initiated.

Data Analysis Statistical data analysis using Minitab version 14 to determine the mean change from baseline of lab
values for the specific metabolic parameters.

Findings/Discussion Participation in diabetes education showed a significant decrease in mean HbA1C levels, TC and LDL-C
levels. Participation in DE and PS groups lead to a decrease in HbA1C, Systolic blood pressure, and TG-
C.
Appraisal/Worth to Maintaining appropriate metabolic parameters are important in managing and preventing chronic
practice complications in diabetes.

APA Citation for Article Ing, C. T., Zhang, G., Dillard, A., Yoshimura, S. R., Hughes, C., Palakiko, D.-M., …
Kaholokula, J. K.
(2016). Social Support Groups in the Maintenance of Glycemic Control after Community
Based Intervention. Journal of Diabetes Research, 1–8.
https://doi.org/10.1155/2016/7913258
Author(s) - Qualifications Ing (2016), Dr. PH, University of Hawaii, School of Medicine, Honolulu, HI, Zhang (2016), Dr.
PH, University of Hawaii, School of Medicine, Honolulu, HI, Yoshimura (2016), RD Dietitian,
Honolulu, HI, Hughes (2016), Dr. PH, RD Kokua Kahili Valley Comprehensive Family Services.
Background/Problem Examine how diabetes-specific social support groups along with a diabetes self-management
Statement education intervention together improve glycemic control and self-care behaviors in patients with
type two diabetes. The goal is to measure if the addition of social support groups to a diabetes
self-management education intervention would be beneficial as a component to maintenance of
improvements.
Conceptual/theoretical The authors failed to mention the use of a theoretical or conceptual framework.
Framework
INTEGRATIVE LITERATURE REVIEW 15

Design/Method Quasi-experimental pre-implementation and post -implementation.


If appropriate, Philosophical
Underpinnings

Sample/ Setting/Ethical 65 participants who were diagnosed with type two diabetes were chosen from local communities.
Considerations Baseline assessment was done, and Partners in Care intervention was done. At three-month
assessment 47 participants were randomly chosen to participant in six support group meetings (25
participants) and 22 participants were placed in the control group and given standard follow up. At
the six-month assessment participants were assessed using survey as well as blood stick
measurements for metabolic parameters comparison of baseline results. The Institutional Review
Boards of the Native Hawaiian Health Care Systems and University of Hawaii at Manoa approved
the study. The researchers had no conflicting interest. Informed consent of participants was
obtained.
Major Variables Studied Social support group vs control group
(and their definition), if
appropriate

Measurement Tool/Data Fingerstick sample of blood taken at baseline, 3 month, and 6-month mark.
Collection Method Survey measuring understanding of diabetes self-care activities tool consisting of 12 items with a
Likert-type response.

Data Analysis Statistical data analysis using ANCOVA comparisons between mean baseline measurements and
participants mean responses to survey.

Findings/Discussion The results of the study found improvements to HbA1C, diabetes-related self-management
knowledge, and behaviors improved from baseline to 3- month assessment. The SSG compared to
the control group had a significant decrease in systolic blood pressure at the 3-month and 6-month
assessment.
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Appraisal/Worth to practice Diabetes- related social support groups in conjunction with diabetes self-management
interventions can improve diabetes functioning, self-care activities and overall quality of life. It
can also lead to a decrease in chronic complications associated with diabetes.

APA Citation for Article Aziz, Z., Riddell, M. A., Absetz, P., Brand, M & Oldenburg, B. (2018). Peer support to improve
diabetes care: An implementation evaluation of the Australasian peers for progress
diabetes program. BMC Public Health, 18(1), 1-12. https://doi.org/10.1186/s12889-018-
5148-8

Author(s) - Qualifications Aziz (2018), MPH is a PhD candidate in the School of Population and Global Health, University
of Melbourne, Australia, Riddell (2018), PhD is a Senior Research Fellow at the School of
Clinical Sciences at Monash Health. Absetz (2018), PhD is a Research Director at the University
of Eastern Finland, Department of Public Health and Clinical Nutrition. Oldenburg (2018) a
professor and Chair of Non-Communicable Disease control in the School of Population and
Global Health University of Melbourne, Australia.
Background/Problem There have been studies that have demonstrated the effectiveness of peer support in promoting
Statement diabetes control. The purpose of the study is to evaluate the implementation of a Peers for
Progress Diabetes Program (Pfp-Dp) in Australia
Conceptual/theoretical The theoretical frameworks that were used were Glasgow’s Reach, Effectiveness, Adoption,
Framework Implementation, and Maintenance (RE-AIM) and Pronk’s Penetration, Implementation,
Participation, and Effectiveness (PIPE).
Design/Method The design of the study was an experimental randomized control trial. Participants attended
If appropriate, Philosophical monthly group meetings facilitated by a trained peer leader for 12 months. Data was collected via
Underpinnings surveys on the intervention’s reach, participation, implementation fidelity, groups’ effectiveness
and participants’ perceived support and satisfaction with the intervention. Participants had clinical
blood testing including (HbA1c, cholesterol, and LDL: HDL ratio drawn at baseline, 6 months,
and 12-month follow-up.
Sample/ Setting/Ethical 24 support groups consisting of a total of 273 participants. The study received ethics approval
Considerations from the Monash University Human Research Ethics Committee. No conflict of interest with the
authors of the study. Participants were given informed consent.
Major Variables Studied The evaluation of the Pfp-Dp was measured on the intervention’s reach, participation,
(and their definition), if implementation fidelity, groups’ effectiveness and participants’ perceived support and satisfaction
appropriate
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Measurement Tool/Data
Collection Method Participants completed an evaluation questionnaire of the program at the conclusion of the 12-
month intervention.

Data Analysis A descriptive analysis using SPSS was used to calculate a coefficient for each component of the
framework evaluation tool.

Findings/Discussion The findings show that


group-based peer support programs positively impact individuals with type II diabetes in
improving their diabetes control. The authors of the study recommend that there is a need for more
research to bring more structured and effective peer support programs to individuals diagnosed
with type II diabetes.

Appraisal/Worth to practice Interventions like the Pfp-Dp help in assisting patients diagnosed with Type II diabetes to self-
manage the disease as well as provide appropriate support and management. Interventions that are
similar can be used to assist in daily health management, provide emotional and social support,
promote and support links to clinical primary care and community resources.

APA Citation for Article Johansson, T., Keller, S., Sönnichsen, A. C., & Weitgasser, R. (2017). Cost analysis of a peer
support programme for patients with type 2 diabetes: A secondary analysis of a controlled
trial. European Journal of Public Health, 27(2), 256–261. https://doi.org/10.1093/eurpub/ckw158

Author(s) - Qualifications Johansson (2016), M.D, Institute of General Practice and Family Medicine, Paracelsus Medical
University, Salzburg, Austria, Keller (2016) M.D., Institute of General Practice and Family
Medicine, University of Witten/Herdecke, Witten, Germany, Sönnichsen(2016), M.D.,
Department of Internal Medicine, Salzburg, Austria, Weitgasser(2016), Paracelsus Medical
University, Salzburg, Austria.
Background/Problem
Statement Treatment of diabetes as well as the potential for complications from the disease can lead to costly
outcomes for patients. The aim of the study is to explore if group-based peer support as an
INTEGRATIVE LITERATURE REVIEW 18

additional component to disease management program (DMP) in type II diabetes can reduce the
number of prescribed drugs, hospital admissions, and length of hospital stay (Johansson, Keller,
Sönnichsen, & Weitgasser, 2016).
Conceptual/theoretical None
Framework

Design/Method Post-hoc controlled study based on a secondary data analysis of a 24-month randomized control
If appropriate, Philosophical intervention trial.
Underpinnings

Sample/ Setting/Ethical 148 people (19 groups) receiving the intervention 189(20 groups) in the control group. Informed
Considerations consent was obtained by participants. Study was approved by the ethics committee of the
providence of Salzburg.
Major Variables Studied Group based peer support influence on the number of prescription drugs, length of hospital stays,
(and their definition), if and number of hospitalizations.
appropriate

Measurement Tool/Data Data and outcome measures were collected via the costs database Folgekosten Datenbank through
Collection Method health insurance records.

Data Analysis Data was analyzed using SPSS Statistics 20.0. A descriptive and effectiveness analysis was
performed based on the FOKO-data. The Mann-Whitney U test was used on non-normal
distributions to detect differences between groups.

Findings/Discussion Providing peer support programs to strengthen lifestyle interventions for individuals diagnosed
with type II diabetes can be a cost-effective model. Peer support can also be beneficial in lower
length of hospital stay which can in turn decrease health care costs and allow for more funds to be
allocated to support more research in the benefits of peer support to improve patient compliance
with their treatment regime.
Appraisal/Worth to practice Peer support programs used to reduce healthcare cost associated with complications of diabetes is
beneficial in helping to reduce recurrent hospitalizations and increase in prescribed medications.
INTEGRATIVE LITERATURE REVIEW 19

APA Citation for Article Peimani, M., Monjazebi, F., Ghodssi-Ghassemadabi, R., & Nasli-Esfahani, E. (2018). A peer
support intervention in improving glycemic control in patients with type 2 diabetes. Patient
Education & Counseling. 101(3), 460–466. https://doi.org/10.1016/j.pec.2017.10.007
Author(s) – Qualifications Peimani(2018), MPH , Department of Health Education& Promotion, School of Public Research,
Tehran University of Medical Sciences, Tehran, Iran, Monjazebi(2018), Department of Health
Education& Promotion, School of Public Research, Tehran University of Medical Sciences,
Tehran, Iran, Ghodssi-Ghassemadabi and Nasli-Esfahani (2018), PhD. Diabetes Research Center,
Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical
Sciences, Tehran, Iran
Background/Problem Diabetic patients experience complications that are costly and decrease quality of life. Self-support
Statement for diabetes management needs to be provided on a long-term basis to help address complications
that may arise from diabetes. Peer support intervention is a cost-effective method to improve self-
care behaviors, self-efficacy, and quality of life.
Conceptual/theoretical The authors of the study failed to mention a theoretical or conceptual framework.
Framework

Design/Method Quantitative semi-experimental pre implementation and post implementation comparison.


If appropriate, Philosophical
Underpinnings

Sample/ Setting/Ethical 200 participants were selected; 100 were in the control group which received basic education from
Considerations a diabetes educator. 100 participants were in the peer lead support group. Intervention consisted of
weekly meetings over a six-month time frame. Obtained approval from Medical Research Ethics
Committee of the Tehran University of Medical Sciences. Participants were give written informed
consent forms and were informed of option to withdraw from study at any time.
Major Variables Studied Self- care behaviors, self-efficacy beliefs, clinical outcomes (Ha1c and Body Mass Index), and
(and their definition), if quality of life.
appropriate

Measurement Tool/Data Baseline clinical and demographic data was collected. Pre-intervention questionnaires were
Collection Method completed by participants based on the four outcomes measured: self-management (Diabetes Self-
INTEGRATIVE LITERATURE REVIEW 20

Management Questionnaire), Self- Efficacy (Diabetes Management Self- Efficacy Scale), and
quality of life (Swedish Health-Related Quality of life Survey). Following the intervention
participants were asked to complete the questionnaires. Post implementation clinical measures
(Ha1C and BMI) were retrieved from participants.
Data Analysis Descriptive statistics were used to summarize the characteristics, frequencies and percentages for
the sample data collected from the questionnaires completed by participants. The Chi-squared test
as used to analyze and compare data between the two groups (control and intervention group).

Findings/Discussion There was a significant decrease in the mean Ha1C value in the intervention group compared to
the control group. There was also an increase in the mean score in the quality of life category.
Further research needs to be made about implementing, designing and evaluating different models
of peer support to meet the needs of different populations

Appraisal/Worth to practice Incorporating peer support interventions into diabetes education programs is a great method to
improving behavioral and psychological outcomes with people with type II diabetes. Peer support
can allow for healthcare providers to further meet the needs of patients and enhance health care
delivery.