Collaborative Formative Evaluation for Implementation of Primary Care–Based Peer Support in the Shanghai Integration Model

Abstract

Peer support (PS) is effective in promoting diabetes self-management, but pragmatic models are needed for specific cultural contexts and healthcare systems. Although rare in China, recent government priorities have created opportunities for PS by encouraging the integration of specialty/hospital with primary/community care. In particular, the Shanghai Integration Model coordinates specialty/hospital care with primary care in Community Health Centers (CHCs), providing an organizational base for implementation of PS. This study reports formative evaluation for PS within the Shanghai model, emphasizing collaboration with CHCs. Intervention refinement was guided by structured interviews with 15 CHC staff and patients and a focus group with as well as monthly feedback from CHC staff. Based on these, the intervention emphasizes education on medication use, healthy diet, and sustaining physical activity among older adults, and addresses diabetes distress and barriers to insulin treatment. Results of this collaborative formative evaluation include focus on group as opposed to individual PS with theme-based, interactive activities co-led by CHC staff along with peer leaders. In addition, peer leaders follow-up with individuals and organize neighborhood activities for physical activity, healthy diet, and feelings of comradery. To date, PS has been implemented in 9 CHCs, involving 74 trained peer leaders, reaching 885 adults. Mean age is 68.24, years with diabetes is 12.52, and HbA1c lower than expected at 7.36%. Counter to common difficulties in reaching men, 41.1% are male. Only 14.2% are taking insulin but 75.9% take oral medications. Important implementation benchmarks include clinician buy-in, high retention, positive participant and peer leader feedback, and extension of programs through engagement with neighborhood residential committees. Collaboration with CHC staff in program refinement have been important in implementation success. Disclosure M.M. Coufal: Research Support; Self; Sanofi, Merck Foundation, Novo Nordisk Inc. P.Y. Tang: Research Support; Self; Sanofi, Merck Foundation, Novo Nordisk A/S. E.B. Fisher: Research Support; Self; Sanofi, Novo Nordisk Inc.. Consultant; Self; Novo Nordisk Inc.. Research Support; Self; Merck Foundation. W. Jia: None.