IDF21-0521 Peer Support for Diabetes Management in the Shanghai Integration Model Developed Community Capacity to Combat COVID-19

Abstract

Background: The Shanghai Integration Model linking primary, specialty, and hospital care includes peer support to help individuals carry out daily management of their diabetes. Initial results from 9 Community Health Centers (CHCs) in Shanghai documented improvements in glycated hemoglobin and other clinical and quality-of-life measures. Expansion to 12 additional communities enlisted neighborhood committees and Community Self Management Groups as well as CHCs to host and promote PS activities. Planned implementation from May 2019 to May 2020 was, however, interrupted by COVID. During the pandemic, peer support for diabetes management was reduced but maintained through WeChat groups and individual contacts while peer leaders also emerged as dependable community partners in responding to COVID-19. Aim: Characterize how the pandemic revealed a broader benefit of the Shanghai Integration Model and peer support in the capacity they provided CHCs and communities to respond to COVID-19. Method: Descriptive and qualitative study of program developments and observed benefits based on structured interviews with key informants among CHC staff, and community and district-level public health officers. Routine documentation of program activities. Results: As part of the proactive, highly coordinated responses of the Chinese government and citizens and the people’s shared sense of duty, peer supporters took an important role in their communities in Shanghai. In initial months of strict lockdowns, peer support pivoted from in-person activities to digital and telephone support. In 9 of 12 communities, peer leaders formed online WeChat groups that became valuable sources both for sustaining diabetes management and responding to COVID. These WeChat groups facilitated clinic-to-patient communication, community peer support, healthy lifestyles, and disseminated credible information about COVID as well as about obtaining medications and clinical services for diabetes. Respondents to structured interviews indicated that peer leaders assisted in their communities in various ways, such as distributing publicity materials, bringing groceries and supplies to older adults who could not leave their buildings, and distributing face masks. Illustrative comments included “Our diabetes team members are not just an audience during the entire epidemic prevention process…they actually give full play to their power as volunteers” and, “The cohesion, the coordination, the willingness to help, and the activity are important factors of a group leader. Those group leaders have put incredible efforts into the prevention and control of the COVID-19 epidemic.” A district level public health officer added, “These group leaders also help in society…they were basically active in all types of social welfare activities.” In addition to serving others, the collaborative relationships cultivated with other organizations created a basis for supporting each other when “everyone was under great pressure. Both leaders and colleagues cared for and encouraged each other, which was consistent with the emotional support content in the peer support program.” Discussion: Beyond direct benefits with diabetes, integration of care such as through the Shanghai Integration Model, peer support, and collaboration with community groups as well as CHCs enhance community capacity to address other health challenges, including even the unprecedented threats provided by COVID-19 in China and worldwide.