Patient Engagement and Coaching for Health (PEACH)

1. Patient Engagement and Coaching for Health (PEACH) An intensive treatment intervention for patients with type 2 diabetes in disadvantaged communities. Consumer consultation phase. Furler J, Walker C, Blackberry I, Hadj E and Young D

2. What is PEACH? • A research project involving Practice Nurses in General Practice and the COACH technique to enable people to manage their type 2 diabetes more effectively

3. Overview of PEACH • Consumer consultation phase (Qualitative) • Cluster Randomised controlled trial phase (Quantitative) • Post-intervention workshop phase (Qualitative)

4. Objective • To determine the patient level barriers and facilitators to implementing a program of telephone coaching for type 2 diabetes in a General Practice setting in a disadvantaged community

5. Methods (1) • Flyers in English, Turkish and Arabic distributed to invite people with type 2 diabetes who reside in the Hume Moreland region of Melbourne’s North West • 2 English speaking groups (13 and 11 type 2 diabetes participants), 1 Turkish speaking group (12 participants) and 1 Arabic speaking group (18 participants) • Consent form/ethics • Interpreter

6. Methods (2) • Two groups with English speaking patients explored the impact of diabetes on their life, their perceptions of the role self management, the role of social support and its relationship to accessing health care, and the barriers and enablers to participating and remaining in the telephone coaching program. • Focus groups with Arabic and Turkish speaking patients explored important cultural factors in self-management and telephone coaching.

7. Diversity of English skills Dominance of emotional issues Resentment and anxiety at the diagnosis Diet (negative) and exercise (positive) emotionally laden Importance of family support Relationship with health professionals Importance of Community Health Services Poor understanding of diabetes monitoring Interpreter budget Explore capacity of COACH technique to engage with these issues Need to explore individual views Need to ascertain dominant relationship Linking patients to other services in the area within COACH Need to explore individual level of understanding Finding from English speaking groups and its implication

8. Congruence with COACH Poor understanding on the role of telephone coaching Concern over substitute for GP services Confusion with other diabetes programs GP central to care Greater commitment to medication and less focus on self management through diet and exercise Dominant role of stress Finding from Turkish and Arabic groups and its implication • Clarification as an element of COACH • Need to clarify coach program focus • Recruitment needs strong GP endorsement • Need continuing coach role reinforcement • COACH needs to explore individual beliefs in relation to self-management

9. Discussion • Focus groups suggest that emotional issues and family relationships are significant factors in adopting self-care behaviours. • These issues may pose greater barriers than lower SES and residing in areas of greater disadvantage.

10. Implications for policy, delivery or practice • We will incorporate our findings in the COACH program • Coaching patients to play a more active role in expecting intensive structured care seems congruent with the wishes of patients. • Priming GPs to be receptive to this may be important.

11. Patient Engagement and Coaching for Health (PEACH) Dr Irene Blackberry PEACH study coordinator Dept of GP, The University of Melbourne 200 Berkeley St, Carlton VIC 3053 Email: i.blackberry@unimelb.edu.au www.peach.unimelb.edu.au