Behavioral health coaching for rural-living older adults with diabetes and depression: an open pilot of the HOPE Study

Aanand D Naik,Craig D White,Suzanne M Robertson,Briana Lawrence,Maria E A Armento,Linda A Stelljes,Jeffrey A Cully

doi:10.1186/1471-2318-12-37

Abstract

BackgroundPatients with diabetes are at increased risk for depression, compounding the burden of disease. When comorbid with diabetes, depression leads to poorer health outcomes and often complicates diabetes self-management. Unfortunately, treatment options for these complex patients are limited and comprehensive services are rarely available for patients in rural settings.MethodsA small open trial was conducted to test the acceptability, feasibility and preliminary outcomes of a telephone-delivered coaching intervention for rural-dwelling older adults with uncontrolled diabetes and comorbid, clinically significant depressive symptoms. A total of eight older adults were enrolled in Healthy Outcomes through Patient Empowerment (HOPE), a 10-session (12-week), telephone-based coaching intervention. Primary study constructs included measures of diabetes control (Hemoglobin [Hb] A1c), depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), and diabetes-related distress (Problem Areas in Diabetes Scale [PAID]). Assessments were conducted at baseline, post-intervention, and 6-month follow-up. Acceptability and feasibility were evaluated using patient surveys, focused exit interviews, and session attendance data.ResultsClinically significant improvements were realized post-intervention and at 6-month follow-up for outcomes related to diabetes and depression. Effect sizes using Cohen's d were determined post-intervention and at 6-month follow-up, respectively, for HbA1c (d=0.36; d=0.28), PHQ-9 (d=1.48; d=1.67, and PAID (d=1.50; d=1.06) scores. Among study participants, HbA1c improved from baseline by a mean (M) of 1.13 (SD=1.70) post-intervention and M=0.84 (SD=1.62) at 6 months. Depression scores, measured by the PHQ-9, improved from baseline by M=5.14 (SD=2.27) post-intervention and M=7.03 (SD=4.43) at 6-month follow-up. PAID scores also improved by M=17.68 (SD=10.7) post-intervention and M=20.42 (SD=20.66) from baseline to 6-month follow-up. Case examples are provided for additional context and to more fully articulate salient intervention concepts.ConclusionAlthough preliminary, data from this small open trial suggest that HOPE holds the potential to improve both physical (diabetes) and emotional (diabetes distress, depression) health outcomes and that changes can be maintained over a 6-month time period. As envisioned by the authors, HOPE may function as an extension of traditional primary care for rural-dwelling older adults with multiple comorbidities. A future randomized clinical trial will test HOPE’s broader effectiveness with rural-dwelling older adults.Trial registrationNCT01274715

Highlights

Patients with diabetes are at increased risk for depression, compounding the burden of disease
A few studies currently under way utilize cognitive behavioral therapy, but these are again focused on either depression [14] or diabetes self-care [15] and not on behavior change techniques that can be applied to both conditions
Procedure All procedures for the Healthy Outcomes through Patient Empowerment (HOPE) trial were approved by the Baylor College of Medicine Institutional Review Board (IRB) and the Michael E

Summary

Introduction

Patients with diabetes are at increased risk for depression, compounding the burden of disease. Depression leads to poorer health outcomes and often complicates diabetes self-management. Depression leads to poorer health outcomes and often complicates diabetes selfmanagement [2,3,4,5]. Multidisciplinary treatments for diabetes and depression are possible, access to such care is highly limited, especially for rural-dwelling older individuals [6,7]. It is far more common for patients with complex diabetes and depression to receive inadequate or uncoordinated treatment for these conditions [8,9,10]. Behavioral strategies that activate patients to perform health behaviors for both diabetes and depression hold the potential to improve both the emotional and physical health difficulties of these medically complex patients

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Discussion

Conclusion