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OBJECTIVE: To improve the quality of peer leader training, this study developed a theory-based self-management training program for older adult peer leaders with diabetes and assessed its feasibility. BACKGROUND: Current self-management programs are designed mainly to be implemented by healthcare professionals, but healthcare staff may not fully perceive the needs and obstacles of older adults in disease management due to a lack of similar illness experience. To target this problem, peer leaders with successful self-management experiences, similar cultural backgrounds and languages, and related illness experiences are trained to guide and mentor peer patients in self-management programs. STUDY DESIGN AND METHODS: This study was conducted in two stages. In stage 1, a peer leader training program was developed based on experiential learning theory as the framework and self-regulation theory as the activity design strategy. In stage 2, program feasibility was assessed via participants' feedback toward the training program by three indicators: attendance, future willingness to lead the peer-led self-management program, and leadership skills evaluated by a peer leader training assessment tool. RESULTS: In this study, peer leaders demonstrated good leadership skills by expressing active willingness to lead self-management programs in the community. Peer leaders' feedback indicated that the program's training content was helpful in preparing peer leaders to guide older adults in learning self-management skills and in improving the abilities and confidence of peer leaders in mentoring self-management. CONCLUSION: Findings in this study showed that peer leader training can impact the effectiveness and success of self-management in older adults with diabetes. Even in a small-scale study, the impact was evident, which demonstrated the feasibility of the program. More large-scale studies on the effectiveness of various peer leader training programs in diverse disciplines are recommended. CLINICAL TRIALS REGISTRY: ClinicalTrials.gov Identifier: NCT04298424 (the Peer-Led Self-Management Program).
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BACKGROUND: Patients undergoing maintenance hemodialysis (MHD) have a significantly higher prevalence of hepatitis C virus (HCV) infection and malnutrition-inflammation complex syndrome (MICS). In the present study of Taiwanese MHD patients, we determined the clinical characteristics and influence of HCV infection on MICS by calculation of the malnutrition-inflammation score (MIS). METHODS: This was a prospective longitudinal study performed at a single hemodialysis (HD) center in Taiwan from September 2007 through March 2008. The study enrolled 58 patients (38%) in the active HCV group and 95 patients (62%) in the non-HCV group. The two or three weekly HD sessions of all patients were followed for 7 months. The MIS was assessed using 10 components, 7 from the conventional subjective global assessment of nutrition and 3 additional elements, body mass index, serum albumin and total iron-binding capacity. RESULTS: HD vintage and total MIS score were greater in patients with active HCV. The active HCV group had significantly longer dialysis vintage and lower total cholesterol but higher total MIS score than the non-HCV group. The MIS 5 score, a measure of major comorbid conditions (including number of years on dialysis), was also significantly higher in the active HCV group. CONCLUSION: MHD patients with active HCV infections have more severe MICS-associated metabolic and physiological disease than MHD patients without active HCV infection.