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

BMC Geriatrics

Research Article

Linda A Stelljes¹  Suzanne M Robertson²  Maria E A Armento²  Craig D White³  Jeffrey A Cully⁴  Briana Lawrence⁵  Aanand D Naik⁶ 

[1] VA HSR&D Houston Center of Excellence, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, USA;VA HSR&D Houston Center of Excellence, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, USA;Department of Medicine, Baylor College of Medicine, Houston, TX, USA;VA HSR&D Houston Center of Excellence, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, USA;Department of Medicine, Baylor College of Medicine, Houston, TX, USA;Department of Psychology, Texas A&M University, College Station, TX, USA;VA HSR&D Houston Center of Excellence, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, USA;Department of Medicine, Baylor College of Medicine, Houston, TX, USA;Menninger Department of Psychiatry and Behavioral Science, Baylor College of Medicine, Houston, TX, USA;VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA;VA HSR&D Houston Center of Excellence, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, USA;Department of Medicine, Baylor College of Medicine, Houston, TX, USA;The University of Texas School of Public Health, Houston, TX, USA;VA HSR&D Houston Center of Excellence, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, USA;Department of Medicine, Baylor College of Medicine, Houston, TX, USA;The University of Texas School of Public Health, Houston, TX, USA;Menninger Department of Psychiatry and Behavioral Science, Baylor College of Medicine, Houston, TX, USA;VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA;

关键词: Diabetes;    Depression;    Goal-setting;    Action planning;    Telephone based health coaching;    Geriatrics;    Older patients;   

DOI  :  10.1186/1471-2318-12-37

 received in 2011-11-03, accepted in 2012-07-03,  发布年份 2012

来源: Springer

【 摘 要 】

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

【 授权许可】

CC BY   
© Naik et al.; licensee BioMed Central Ltd. 2012