Protocol for partnering with peers intervention to improve medication adherence among African Americans with Type 2 Diabetes

African Americans (AAs) with diabetes are more likely to develop diabetes-related complications and have the highest diabetes-related mortality rates, than all other racial/ethnic groups. These health disparities are primarily due to poor medication adherence (defined as not taking medications as prescribed). AAs have substantially lower adherence to diabetes medications than whites, which contributes to higher rates of diabetes-related complications, such as amputations and strokes. There is a critical need to develop diabetes self-management interventions that improve medication adherence, clinical outcomes and in turn reduce morbidity and mortality among AAs with diabetes. Focusing on psychosocial factors such as health beliefs, self-efficacy and patient-provider communication is instrumental to improving AAs medication adherence. To address this need, we developed, the Peers Supporting Health Literacy, Self-Efficacy, Self-Advocacy, and Adherence (Peers LEAD) intervention, which provides AAs with culturally adapted diabetes and medication beliefs information, one-on-one peer support from AAs with diabetes, and communication and self-efficacy skill development to enhance medication adherence. This pilot research is a pre-post single group intervention study design which will be conducted in two phases using a community engaged approach. The objective is to test the Peers LEAD intervention in Phase 1, and then examine specific intervention elements for refinement in Phase 2. We will employ both quantitative and qualitative methods to assess the feasibility, acceptability, and outcomes of Peers LEAD. Building on established community partnerships, we plan to recruit and enroll 30 Peer Buddies and 20 Peer Ambassadors to participate in the intervention. By utilizing patient feedback to refine Peers LEAD and piloting it to examine its feasibility, we will generate evidence regarding its real world use and provide support for a randomized controlled trial of its impact on AAs diabetes medication adherence and clinical outcomes.