The following is a summary of “Pilot trial results of D-HOMES: a behavioral-activation based intervention for diabetes medication adherence and psychological wellness among people who have been homeless,” published in February 2024 issue of Psychiatry by Vickery et al.
Diabetic Homelessness (DH) individuals face self-care barriers due to comorbidities. Limited research explores effective interventions like lay health coaching.
Researchers conducted a retrospective study to examine engagement strategies for DH individuals, utilizing lay health coaching efficacy and behavioral activation.
They used community-engaged research to develop the Diabetes HOmeless MEdication Support (D-HOMES) program, a 3-month coaching intervention. A pilot randomized trial compared D-HOMES to enhanced usual care (EUC) for English-speaking adults with type 2 diabetes and recent homelessness, focusing on feasibility, acceptability, and clinical outcomes. The primary clinical outcome was glycemic control (HbA1c), and the behavioral outcome was Medication Adherence.
They utilized community-engaged research and incremental behavioral treatment development to create the Diabetes HOmeless MEdication Support (D-HOMES) program. A 3-month coaching program targeted medication adherence and psychological well-being for homeless individuals. Results of their pilot randomized trial, comparing D-HOMES to enhanced usual care (EUC), were presented, focusing on feasibility, recruitment, retention, engagement, and acceptability using the Client Satisfaction Questionnaire (CSQ-8). The primary clinical outcome assessed was glycemic control (HbA1c), with medication adherence as the primary behavioral outcome, while secondary outcomes included psychological wellness and diabetes self-care.
The results showed 36 participants, evenly split between groups (18 each), predominantly Black males with high comorbidities residing in subsidized housing. Retention rates were high: 100% at three months and 94% at six months. Satisfaction was high (mean CSQ-8 scores=28.64 [SD 3.94] of 32). Both groups saw clinically significant HbA1c reductions, with no inter-group differences. D-HOMES showed more significant mean blood pressure improvement at six months than EUC, systolic -19.5 mmHg (P=0.030), and diastolic blood pressure -11.1 mmHg (P=0.049). Other secondary outcomes showed no significant differences between groups.
Investigators concluded that recruiting and retaining DH individuals over 6 months was successful. Preliminary results suggest significant blood pressure improvements favoring D-HOMES, warranting further investigation in a fully powered trial to promote health equity.
Source: frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1329138/full