Innovative Research Project Teaches Families How to Manage Type 2 Diabetes Together

By Tom McLaughlin

Successful diabetes management may soon begin closer to home – with the help of easily accessible, online interactive learning – thanks to a new Rutgers University–Camden research project.

The research project teaches family members communication strategies to help their loved ones manage Type 2 diabetes successfully.

The innovative “Family Members as Coaches for Patients with Type 2 Diabetes” pilot project, funded by the New Jersey Health Foundation, teaches people with Type 2 diabetes and their family members a host of effective communication strategies in order to help their loved ones manage the disease successfully.

“Most diabetes management occurs in the home and with the help and sometimes hindrance of family members,” says Kristin August, associate professor of psychology and director of the Health Sciences Center at Rutgers–Camden. “Consequently, our focus is on figuring out if family members can be versed in more positive forms of communication that will ultimately lead to better diabetes management and improved family functioning.”

The research project partners Rutgers–Camden with Cooper University Health Care, Jefferson Health, and Virtua Health to bring together small groups of dyads – pairs comprised of a person with Type 2 diabetes and a family member – for four monthly, virtual sessions. The participants learn communication strategies such as active listening and providing positive feedback, among others. The patients’ behaviors and attitudes are assessed via surveys and focus groups at the beginning of the intervention, immediately following it, and three months later.

August notes that most diabetes management occurs in the home and with the help and sometimes hindrance of family members.”

“Diabetes education helps patients gain the tools necessary to manage their diabetes successfully,” says August, who leads the project with Kathleen Jackson, a clinical assistant professor in the Rutgers School of Nursing–Camden. “Coaching, which involves a structured, supportive relationship, helps them to become more confident and motivated in their abilities to follow their regimen. We posit that the most effective coaches can be patients’ family members.”

The first cohort of 11 dyads attended the monthly meetings from October 2019 through March 2020, when the COVID-19 pandemic brought the sessions, data collection, and recruitment to a standstill. The researchers then adapted the project to implement virtual sessions, which began this November.

According to August, they spent several months figuring out the logistics of hosting the group sessions, breakout rooms, and one-on-one conversations. They also modified visual aids to present the information on a computer, and utilized an existing, online version of their assessment survey.

The Rutgers–Camden researchers further taught participants how to use the software and to minimize distractions in their home environment. Erika Pitsker, a senior health sciences major – and one of four Rutgers–Camden undergraduate students assisting August on the project – notes that the dyads and the diabetes educator are still in the same “virtual room” together and are thus still able to build a solid rapport.

Kathleen Jackson, a clinical assistant professor in the Rutgers School of Nursing–Camden, leads the project with August.

“I was actually surprised at how well they all adapted to the online platform,” says the Cumberland County resident. “The participants were all talking and asking questions of one another, and not just the facilitator.”

August says that Pitsker and her fellow Rutgers–Camden students have been particularly vital to the virtual implementation of the project. In addition to their regular responsibilities – conducting literature reviews, taking notes on the sessions, transcribing what was said, and offering their own perspectives of what transpired – the students have been busy recruiting patients since the in-person diabetes education classes were canceled. That includes developing a project Facebook page, creating a recruitment video, and personally reaching out to prospective participants and other diabetes programs across the state.

“In the long run, we may be able to reach even more people with this virtual implementation of the program,” says August. “This is particularly important during the COVID-19 pandemic. People with diabetes have a higher risk for severe illness, so managing their condition right now is more important than ever.”

As it turns out, the Rutgers–Camden students are learning invaluable life skills as well. Pitsker notes that the switch to remote learning – and a virtual implementation of the research project – has required her to strengthen her focus, organizational skills, and overall resilience.

Erika Pitsker, a senior health sciences major, is one of four Rutgers–Camden undergraduate students assisting researchers on the project.

“It’s a challenge, but I am better because of this course,” she says. “As a student, that will translate to the rest of my courses and even my future career in medicine.”

She credits August, as well as Rutgers–Camden’s supportive academic environment – including her advisors in the Honors College – for making the transition to remote instruction easy for students.

“I have never felt alone in that transition,” she says. “I am constantly reminded of the resources available on campus and my Honors College advisors are always there to answer even the silliest, smallest questions. There is always constant communication.”

The Rutgers–Camden researchers will report findings on the diabetes family coaching project next November. However, preliminary survey data show that patients feel “empowered” to have a person available to help coach them through their diabetes management. Moreover, the patients felt that the positive communication strategies were beneficial to their personal relationships in general.

Funded by a Rutgers Community Design for Health and Wellness award, the researchers further plan to host focus groups with primary-care offices in spring 2021 to assess the ability to introduce the program in those settings, as part of a larger-scale implementation of this project. The long-term goal, says August, is to supplement diabetes education more generally with coaching and a package of informational materials for diabetes programs as well as public health programs to use.

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