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Behavioral health coaching for rural-living older adults with diabetes and depression: an open pilot of the HOPE Study
BACKGROUND: Patients 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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3542105/ https://www.ncbi.nlm.nih.gov/pubmed/22828177 http://dx.doi.org/10.1186/1471-2318-12-37 |
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author | Naik, Aanand D White, Craig D Robertson, Suzanne M Armento, Maria E A Lawrence, Briana Stelljes, Linda A Cully, Jeffrey A |
author_facet | Naik, Aanand D White, Craig D Robertson, Suzanne M Armento, Maria E A Lawrence, Briana Stelljes, Linda A Cully, Jeffrey A |
author_sort | Naik, Aanand D |
collection | PubMed |
description | BACKGROUND: Patients 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. METHODS: A 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. RESULTS: Clinically 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. CONCLUSION: Although 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 REGISTRATION: NCT01274715 |
format | Online Article Text |
id | pubmed-3542105 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-35421052013-01-11 Behavioral health coaching for rural-living older adults with diabetes and depression: an open pilot of the HOPE Study Naik, Aanand D White, Craig D Robertson, Suzanne M Armento, Maria E A Lawrence, Briana Stelljes, Linda A Cully, Jeffrey A BMC Geriatr Research Article BACKGROUND: Patients 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. METHODS: A 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. RESULTS: Clinically 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. CONCLUSION: Although 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 REGISTRATION: NCT01274715 BioMed Central 2012-07-24 /pmc/articles/PMC3542105/ /pubmed/22828177 http://dx.doi.org/10.1186/1471-2318-12-37 Text en Copyright ©2012 Naik et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Naik, Aanand D White, Craig D Robertson, Suzanne M Armento, Maria E A Lawrence, Briana Stelljes, Linda A Cully, Jeffrey A Behavioral health coaching for rural-living older adults with diabetes and depression: an open pilot of the HOPE Study |
title | Behavioral health coaching for rural-living older adults with diabetes and depression: an open pilot of the HOPE Study |
title_full | Behavioral health coaching for rural-living older adults with diabetes and depression: an open pilot of the HOPE Study |
title_fullStr | Behavioral health coaching for rural-living older adults with diabetes and depression: an open pilot of the HOPE Study |
title_full_unstemmed | Behavioral health coaching for rural-living older adults with diabetes and depression: an open pilot of the HOPE Study |
title_short | Behavioral health coaching for rural-living older adults with diabetes and depression: an open pilot of the HOPE Study |
title_sort | behavioral health coaching for rural-living older adults with diabetes and depression: an open pilot of the hope study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3542105/ https://www.ncbi.nlm.nih.gov/pubmed/22828177 http://dx.doi.org/10.1186/1471-2318-12-37 |
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