Jun 27, 2017


Announcer: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Diabetes is one of the biggest health epidemics facing us today and managing the disease is important not only for the well-being of those that have it, but also as a way to control healthcare spending since people that don't manage the disease tend to develop more serious chronic complications.

Michelle Litchman is a researcher and diabetes nurse practitioner who is going to study improving Type I diabetes outcomes with an online peer health intervention. And we're going to break this down a little bit and talk about what exactly that means and what it could mean for managing diabetes. So, first of all, tell me about peer health. What does that mean?

Dr. Litchman: Peer health is the interaction, education, and support offered by peers who have the same medical condition to promote health-enhancing change. So, essentially, what that means is when you are trying to find someone else who maybe understands the same things that you are going through, so in Type I diabetes specifically, it makes up only 5% to 10% of the entire diabetes population. So it's kind of an outlier.

And because of that, people can sometimes feel isolated, or they're not able to relate to others in the same way. And so it's kind of the power of "me too" someone else who understands exactly what you're going through. They speak the same language, and they can really understand each other from not just "I give you sympathy," but really an empathetic place.

Interviewer: And provide information and provide support and places to look for resources. It's a community.

Dr. Litchman: Absolutely, it's a community.

Interviewer: Yeah. Are there other comparable communities out there so people maybe could get a better idea what this looks like? Is this a community that meets in person, or, generally, how traditionally has this work?

Dr. Litchman: So it's been a mix. I mean, initially we started out with support groups. And now, because of the online space, there's this online communities that have eventually led to meet-ups in a lot of instances. So there are lots of different types of communities for different types of individuals.

I mean, if you think about health, there are people who want to quit smoking that interact with each other. There are people who might have a more rare condition that interact. I know that people who are managing a child with food allergies, those moms interact and talk to each other.

And definitely, in the space of diabetes, people are talking to each other about the latest research that's happening, about making sure that people feel understood. They're getting knowledge, the resources that you talked about, and I think just that feeling of "someone else gets me," is really, really important.

Interviewer: So what do we know about this concept of peer health and its effectiveness of actually managing types of disease? You mentioned smoking, for example. Does that actually, help people quit or reduce their smoking?

Dr. Litchman: Right. So we know that if you have someone that you've kind of . . . that you're discussing something with, so smoking, like if you commit to smoking and there's someone else there who's there to help coach you along, we know that . . . another great example is Alcoholics Anonymous. You have a peer, someone who else has been an alcoholic who kind of helps coach you through that. The same is true for Overeaters Anonymous.

So I think that if you can have a peer who understands you on a personal level, because they live with that same health condition, they can kind of talk you through the process and not necessarily mentor you, but understand you, there's no hierarchy there, but they really understand what you're going through and can provide resources, and it's reciprocal. So, because of that, there are going to be times when one peer is the deliverer of health support, and there are times when that same person is going to be receiving that kind of peer support from someone else.

Interviewer: So, intuitively, one would think that this type of peer support would be a good thing. But what you're trying to find out is does it actually have an impact on clinical outcomes? Does it actually make their disease condition better?

Dr. Litchman: Right. So we know there's been research on peer support groups that have not been in the online space that have shown some positive outcomes. There are some narrowly focused online research where a researcher may have created their own community, where they're just looking at one community, like maybe just one Facebook group or another type of group. And they're not really comparing it to a control group for one.

And also, we know that people, when they go on social media, they don't just stick to one resource. Oftentimes, people will go to Facebook for one thing, and then there's a different set of people that might be on Twitter, or maybe they read a couple of different blogs. And so we're trying to better understand that whole network. And this study, in particular, will be the first step to kind of understanding that a little bit more.

Interviewer: Sure. We can't make the assumption that just because it works in real life when people are really interacting that it's going to work on the online space. So that's why you're doing what you're doing.

Dr. Litchman: Absolutely.

Interviewer: So your research is based on something called apomediation theory. Did I pronounce that right?

Dr. Litchman: Apomediation theory, yes.

Interviewer: Yeah. So tell me about that theory and how that's guiding what you're doing.

Dr. Litchman: Sure. So apomediation theory, essentially, posits that peers can guide you to correct information. So the way that it used to be is that you only had your physician or your other healthcare provider who would guide you to this correct information. And then the worldwide web came out and people could get this one-way street of information.

So, for example, the CDC website, people could go there or the American Diabetes Association, and it's a one-way street that the association or the organization is giving you information. But you can't really respond, you can't reply, and you don't know if that information is relevant to you.

And so what happens with apomediation theory is you've got peers along the way that, because of their experiential knowledge, they can help guide you to correct information that's going to be relevant for you. So if someone says, "I'm interested in learning more about continuous glucose monitoring or an insulin pump," there are peers out there that can guide you to forums or blogs, or different conversations that are happening online to kind of help support that.

Interviewer: And as kind of an outsider, it would seem to me that maybe that could be a little risky that they might not be getting accurate information. But, actually, this theory shows that most the time they do.

Dr. Litchman: Yeah. So there's been some research in this space with regards to misinformation. I think that's the biggest concern that healthcare providers have, is if someone goes out on the internet, are they going to get correct information? So I think, when it's guided by peers and you're actually within a community, misinformation gets self-policed.

And that was discussed in some of the research, some preliminary work that I've already done where people talked about, you know, they gut check the information first, they look at consensus and numbers to see is it just a couple of outliers that are saying "This is wrong," but also people stand up in the community because they don't want misinformation there.

They stand up in the community and say, "Hey, I don't know that this might be true. There's some other research that shows that the direction might be different." And so I think that there's definitely some self-policing that goes on because the community wants to maintain its reputation for being a source of good information.

Interviewer: I thought that this number was fascinating. Misinformation is infrequent and falls within best practice guidelines 91% of the time.

Dr. Litchman: Yes. So, for that particular study, this was among older adults which, I think, is even more important just because I think that sometimes we worry about older adults getting misinformation and led down the wrong path. I don't want to say that older adults are gullible, but we just worry about making sure that older adults are getting correct information just like we would any population. And this particular study was in an older adult population.

Interviewer: And what would this mean for diabetes management?

Dr. Litchman: So the online community is low cost, and it's available all the time. And so this would actually provide tremendous support to what people are already getting. I think it improves access to knowledge and information. And especially if the misinformation gets weeded out, it's a really great source.

I think that experiential knowledge is important not just to get to some of the nitty-gritty details that sometimes isn't discussed in the healthcare provider appointment, you know, those day-to-day challenges that come up, healthcare providers aren't always called about those. I mean, it would be impossible for that to happen. So I think that understanding how to troubleshoot, manage those day-to-day challenges is really important, which you can gain from peers with experiential knowledge.

I think that we are underestimating the power of social media in healthcare. I think that people are going online for lots of different reasons related to healthcare whether it be to support mental health, which I do think the diabetes online community does support because it kind of gets to that "I understand you. You're not alone in this." But I think that we need to have better ways of measuring this, and we need to put more emphasis in researching this area that's kind of emerging.

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