Table 4 Taxonomy of implementation of peer support strategies in LMIC by mode of delivery

Cameroon

Peers—volunteers with diabetes selected based on their compliance with treatment, good glycaemic and metabolic control, and their experience. Received 2-day training workshop.

Actions—actors led group meetings on self-management and conducted personal and telephone-based support.

Targets—actions were aimed at improving self-care behaviours; knowledge; clinical outcomes (glycaemic levels, blood pressure, lipids); providing emotional and social support for adults with poorly controlled T2DM.

N/A

Dose—Group meetings monthly for 6 months.

Personal + telephone encounters—5 monthly over 6 months.

Justification—Research shows that peer-support care models provide low-cost, flexible means to supplement formal health care support for chronic diseases.

Baumann et al. 2015

Pre-post quasi-experimental study

[44]

Uganda

Peers (called champions)—people with diabetes who were able to read and speak English and receive 2 days training in communication, emotional support, and assistance with daily management. Other selection criteria not specified.

Actions—actors were matched with patient peers and provided emotional support and assistance with daily management through facilitating personal and telephone.

Targets—actions were aimed at improving diabetes self-care behaviours, glycaemic control, social support, emotional well-being, and linkage to health-care providers for adults with T2DM.

N/A

Dose—Contact between peers and partners (telephone/in person) at least once a week over 4 months.

Justification—WHO suggests that peer support is a promising approach toward achieving self-care goals in a developing world setting with shortage of health workers, which is supported empirically.

Eggermont 2011

Pre/post

[45]

Cambodia

Peers—recently recovered from years of serious illness from poor glycaemic control. Received 6 weeks of training.

Actions—actors educated and provided skills of self-management; supported adaptation of life-style including nutrition and daily exercise; and mediated contact to professional health staff when needed.

Targets—actions aimed to improve health outcomes (blood glucose, blood pressure, BMI), ability to control disease, and empower people with diabetes (some also had hypertension).

N/A

Dose—Classes—6 in the home of peer educator.

Monitor glucose levels—twice monthly

Time period not specified.

Justification—Peer support models are theoretically promising for resource constrained health systems and underpins patient-centeredness, supported by some empirical evidence.

Argentina

Peers—patients with diabetes recruited on the basis of their excellent diabetes control, self-motivation, communication and support skills. Recruited from an NGO devoted to education of people with diabetes. Received 3 days training in DSM and communication.

Actions—actors implemented a diabetes educational program, provided psychological and behavioural support through phone calls to patients and face-to-face interviews in small groups.

Targets—The actions aimed at improving and sustaining self-care behaviours and hereby clinical outcomes in adults (25–75 years) with T2DM, who had been followed for at least 2 years by physicians without major co-morbidities.

N/A

Dose—Educational course, 4-week program (4 modules, 90–120 min). 1 reinforcement session 6 months after.

Calls—weekly for 6 months post-course, biweekly next 3 months, and monthly for last 3 months.

Interviews—bimonthly for 1 year post-course.

Justification—Research shows that diabetes self-management education is effective for improving clinical outcomes and quality of life of people with diabetes but many organizations are not equipped to manage its implementation. This gap can be bridged by peer programs, supported by research from other chronic conditions.

South Africa

Peers—volunteers with diabetes who had lost weight and increased exercise after T2DM diagnosis.

Actions—actors (a) led psychoeducational group sessions, (b) facilitated buddy pairs between women with diabetes in order for these women to support each other’s behaviour change via telephone text-communication.

Targets—Actions aimed at enhancing self-management for women with diabetes (1 T1D, rest T2DM) who had suffered diabetes symptoms for more than 5 years. Further, actions aimed to facilitate successful buddy pairs, where women with diabetes would support each other’s behaviour change and hereby clinical outcomes.

N/A

Dose—Psychoeducational group sessions/informational support meetings—12 weekly meetings.

Text-messages—daily. Time period not specified.

Justification—Research suggests that peer support can bring significant improvements in chronic disease diagnosis and care. Formative research informed the adaption of the ‘Power to Prevent Program’ to the study setting.

China

Peers—older people with T2DM, living in the same community, non-health professionals. They were very similar to general participants.

Actions—actors led a social support and self-efficacy enhancing group activities (SSS-activities). Actors facilitated frequent informal contact and collective peer group meetings.

Targets—Older people with T2D (≥ 60 years). Actions are targeted at changing self-management behaviours and subsequent improvement of health outcomes by influencing self-efficacy and social support.

Temporality—Informal peer-led SSS-activities started at the same time as basic diabetes information (BDI) by health professionals. Formal SSS-activities 1 week after ended BDI sessions.

Dose—SSS activities lasted 12 weeks. Informal contact— at least once a week.

Collective group meetings held fortnightly from 5–12th week of study.

Justification—Social cognitive theory used as a framework. Research shows that peer education can be used in health promotion and disease prevention programs to lower costs of health education programs. Formative research provided the basis for development of a peer-led T2D self-management program.

Zhong et al. 2015

RCT

[51]

China

Peers—volunteers, who were retired adults diagnosed with diabetes for a mean of 9.3 years had received training for 3 days in basic skills and DSM. Generally adhered to medication and behavioural management regimens.

Actions—actors led educational meetings on DSM, discussion meetings, and organised informal health promotion and support activities such as physical activities.

Targets—actions aimed at assisting and encouraging daily diabetes management, providing ongoing social and emotional support, linking community resources and primary care for adults (> 15 years) with T2DM without major co-morbidities.

N/A

Dose—educational meetings—12 bi-weekly over 6 months. 1.5-2 h

Discussion groups—12 bi-weekly over 6 months

Informal activities—not specified.

Justification—research suggests that peer support can improve diabetes management. Furthermore, a formative evaluation conducted prior to the study indicated substantial support for the peer-led support program.

Debussche et al. 2018 [50]

Mali

Peers—10 PEs from the list of association members: having diabetes, living in the locality, undergoing regular checks with a referent physician, volunteering to deliver educational sessions.

Actions—actors led culturally tailored structured patient education (3 courses of 4 sessions) including cardiovascular risk management, food intake, exercise, and blood glucose and insulin management.

Targets—actions aimed at evaluating the effectiveness of peer-led self-management education in improving glycaemic control in patients with type 2 diabetes.

Dose—3 courses composed of 4 different thematic sessions (4 ± 10 participants) offered over a period of 3 months (months 1 ± 3, 7 ± 9, and 10 ± 12). The duration of sessions 1.5 ± 2 h

In (LMICs), SME led by community health workers and peers has been reported to make major contributions in the areas of health promotion. However, in the case of (NCDs) such as diabetes, the few studies performed in LMICs have revealed poor outcomes.

Less et al. 2010

Pre/post

[48]

Jamaica

CHW—community health workers classified as local people who were not expected to move away from their communities. Received training and had to complete a standardized questionnaire/test.

Actions—actors provided education in DSM through group and one-to-one sessions either at the clinic or in the patients’ homes, when patients could not come to clinic.

Targets—actions aimed at increasing knowledge and improve control amongst T2DM patients.

N/A

Dose—group sessions and one-to-one interactions—frequency not specified, lasted 6 months.

Justification—Due to high net migration rates, training and retaining diabetes educators as part of primary health care system is not feasible. Peer or lay educators may bridge this gap.

Mash et al. 2014

RCT

[53]

South Africa

CHW (health promoters)—lay people employed by community health centres. They were trained (6 day workshop).

Actions—actor led sessions of group diabetes education using a guiding style of communication and provided counselling.

Targets—actions aimed at enhancing self-management and thus health outcomes for adults with T2DM.

N/A

60 min monthly sessions over 4 months.

Justification—poor and limited health infrastructure in LMIC requires task-shifting to cope with the burden of diabetes.

Micikas et al. 2015

Pre/post

[49]

Guatemala

CHW—nature of these not specified. The actors were selected from a group of community health workers based on interviews. The selected CHW received further training.

Actions—actors led education (diabetes club meetings including self-management education, emotional support, physical activities); advocacy (home visits including emotional and medication support); and pre-consults in the clinics with nurse.

Targets—actions aimed at improving education, support, and ultimately the health and quality of life of T2DM patients.

N/A

Club meetings—weekly

Home visits—weekly

Pre-consults—monthly

Intervention period is not specified but intervention was evaluated after 4 months.

Justification—research shows that community health interventions are an essential component of chronic disease management. Assessments in the intervention villages further underpinned the residents’ strong desire for services provided by community health workers.