An Experimental Study on the Effectiveness of Peer Intervention for African Americans with Chronic Kidney Disease

Introduction

Chronic kidney disease (CKD) is a leading public health problem in the US, affecting about 26 million people. Genetics, age, ethnicity, and unhealthy lifestyles are known to be risk factors associated with CKD.  African Americans are more vulnerable to CKD than other racial groups.  Racial disparity in CKD exists in lower socioeconomic status, higher prevalence and greater severity of diabetes mellitus and hypertension, increased inherited susceptibility of African Americans to kidney damage. Kidney disease-specific knowledge or awareness is a significant risk factor among African Americans.

Pre-dialysis education has been known to slow the progression of kidney failure through education, diet, medication adherence training and exercise. Specifically, peer response is considered to be cost-free and clinically effective with African American with other chronic illnesses.  Peer mentoring training selected patients to listen to, empathize with, a role model for and empower other patients has been demonstrated to be an innovative and effective approach to enhancing communication and providing patients with options to make informed decisions.

The objective of this study is to test the effectiveness of peer psychoeducational intervention for African Americans with CKD to improve their health knowledge and behaviors.

Methods

Funded by DHHS Office of Minority Health to the Renal Division of the University of Mississippi Medical Center, this study used a true experimental design with random selection of participants into either intervention or control group. Both groups were administered a pretest and a posttest at the end of 12 months. While control group with usual clinic visits, only the intervention group participated in the peer mentoring program.  Trained social workers and peers provided patient and family education and supportive counseling. Specifically, cognitive behavioral therapy (CBT) and behavior therapy were focused to change their health belief, knowledge, and life style. After almost 12 months, the Health-related Locus of Control, Health Knowledge Questionnaire, and Health Lifestyle Behavior Questionnaire were administered to examine the significant improvement in in intervention group comparing to pretest scores in control group.  

Results:

The final 165 participants were randomized either to control group (n=82) and intervention group (n=83) at the baseline. More 45-64 aged women in lower socioeconomic status were represented in both groups.  Factorial Analysis of Variance found that CKD health knowledge scores were increased in both groups and healthy life style behaviors were significantly improved only in intervention group. However, there was no statistically significant change in health related locus of control and further, results showed a significant inverse change meaning that internal locus of control decreased in the intervention.

Implications:

Although peer-led psychoeducational intervention was partially proven to be effective, these empirical findings provided social workers with feasible and cost-effective intervention designed by social workers with knowledge about CKD. This research will bring awareness to social workers of the ever-changing cultural diversity in CKD as it relates to belief system that prevent patients from seeking health care. This outcome-based empirical study should be replicated in social work field to enhance evidence-based practice.