Science Advance: Diabetes Self-Management Skills Increased with Support of Local Church Community & the ACTSI

ehealthystides @ Big Bethel Project certified health coach and study participant

The Atlanta Clinical & Translational Institute (ACTSI) established a partnership with Big Bethel AME Church (Auburn Ave., Atlanta) to provide a sustainable community-based research resource for diabetes consultations, health screenings and a web-enabled research recruitment registry. The ACTSI’s Community Engagement Research Program’s (CERP) investigators, in collaboration with Big Bethel and Visions Inc., identified and trained members of the Big Bethel Health Ministry to be certified health coaches. This group of 20 coaches helped over 100 congregants with diabetes to use an ACTSI Biomedical Informatics Program-supported health skills web application (ehealthystrides), improve self-management behaviors and proved that by engaging health coaches, high risk diabetic patients increase their self-management skills.

The ACTSI is a city-wide partnership between Emory, Morehouse School of Medicine (MSM) and Georgia Institute of Technology and is one of a national consortium striving to improve the way biomedical research is conducted across the country. The consortium, funded through the National Center for Advancing Translational Sciences, part of the National Institutes of Health’s Clinical and Translational Science Awards, shares a common vision to translate laboratory discoveries into treatments for patients, engage communities in clinical research efforts and train the next generation of clinical investigators. For the community, and as seen through the ehealthystrides @ Big Bethel Project, this means improved self-management behaviors and clinical outcomes.

The ehealthystrides @ Big Bethel Project implemented a church-based pilot study of an interactive, web-based, patient-driven, diabetes self-management support and social networking forum using ehealthystrides. This project supported a community access kiosk and ehealthystrides web portal that supports training of church members to enhance health literacy and create and maintain a personal health record. The community access kiosk was a vital point of access and was successfully implemented at Big Bethel both in the Crown Room, Bethel Village for Seniors and in their Fellowship Hall. The health coaches provided motivation and support in the acquisition of self-management skills for 108 diabetic church members. The ACTSI’s Biomedical Informatics Program played a leading role in creating the relationship with the Big Bethel AME church and worked closely with CERP and the Big Bethel to design the project.

“We were able to show that by engaging health coaches who worked as peer leaders, high risk diabetic patients were willing and able to enhance their self-management skills. This was provided by statistically significant improvements in blood pressure, blood glucose and amounts of physical activity. The improvements in clinical outcomes that we observed were better than what we saw in a clinic-based pilot of the ehealthystrides application,” said Priscilla Pemu, MD, MSCR, associate professor of clinical medicine at Morehouse School of Medicine, ACTSI investigator and ehealthystides @ Big Bethel Project principal investigator.  

The ACTSI/Big Bethel partnership also provides a community access studio for training ACTSI investigators through culturally competent onsite consultations and presentations of major research results to church members. Big Bethel AME Church was founded in 1847, and is the oldest predominantly African-American congregation in the Metropolitan Atlanta area. African-Americans have the highest percentage of diabetes than any other race. This church is supporting research to fight one of the fiercest diseases plaguing its community. The day-to-day project interactions were managed by the ehealthystrides Steering Committee that included representatives from Big Bethel and were nominated by pastor, Dr. Gregory Eason, and research staff from MSM and Emory. According to Pastor Eason, “The opportunity for medical-spiritual collaboration provided by this project is unique and definitely a positive development. The congregants enjoyed the opportunity to interact with the health coaches and to observe the immediate impact of their behaviors on their clinical measurements.”

The ehealthystrides @ Big Bethel Project led researchers to wonder what interactions between the community-based health coaches and the diabetic participants were most successful. The ACTSI is currently engaged in further analysis to define the successful elements of that interaction, as this will enhance any research dissemination activity within communities. Furthermore, the project demonstrated that among a population of older African-American participants, there was a willingness to engage and use the ehealthystrides web application to work on enhancing self-management skills. This program has now funded two mini-grants to enhance physical activity and healthy eating and the partnership has applied for future funding and is preparing a manuscript describing the clinical outcomes.