Xuxi Zhang

poor health might have enrolled less often. Care activities that require transport or a higher level of activity might not reach older adults who are limited in their functioning. So, it may be important to pay more attention to special groups of older adults, such as people in poor health condition or who are limited in functioning, when we develop further interventions on frailty. Health promotion for chronic conditions The first two steps of public health approach on chronic conditons have been studied thoroughly by previous studies. Diabetes is a chronic condition with significant morbidity and mortality, and over 90% patients with diabetes have type 2 diabetes (T2DM). 26 Due to the heavy burden caused by diabetes in affected individuals, families and societies in general, diabetes has been identified as a major public health problem for several decades. 27 The risk factors for diabetes can be divided into two categories: modifiable (can be changed) and non ‐ modifiable (cannot be changed) factors. 28 Non ‐ modifiable factors include a person’s family history, age, gender, racial/ethnic and socioeconomic status. 29, 30 Modifiable factors that increase the risk of developing diabetes, particularly T2DM, include hyperglycemia, hypertension, hyperlipidemia, obesity, and unhealthy lifestyle. 29, 30 The third step of the public health framework is to determine how to prevent or control the problems. On ‐ going changes in lifestyle including losing weight, increasing physical activity, eating healthy foods, medication management and monitoring clinical and metabolic parameters have been shown to be effective in better management and control of diabetes as well as its complications, especially for T2DM. 30 ‐ 32 However, these changes in lifestyle are difficult for the adults with T2DM due to the requirement of strong self ‐ management or self ‐ regulation skills. 31, 33 Peer support, a kind of ongoing support from nonprofessionals, may effectively provide ongoing self ‐ management support. 31 Therefore, we evaluated the existing peer support interventions and compared their effects to find out what works better in management of T2DM (see Figure 9.1.2). In Chapter 6 , the effects of peer support on glycemic control for patients with T2DM and the important characteristics among providers, types, intervention duration and effect duration were studied through meta ‐ analysis among relevant randomized control trials (RCTs). Peer support was found to achieve modest but statistically significant benefits on glycemic control for patients with T2DM. Peer support provided by patients themselves as a group or provided by nonprofessionals like community workers may have significantly better effect. Duration >3 and  ≤ 6 months is more likely effective and the effect of peer support on glycemic control weakens over time especially after the end of intervention, which points to the importance of ongoing support. 34 According to the results of our study, Curriculum ‐ combined ‐ reinforcement ‐ intervention and Home ‐ visit ‐ intervention were suggested, and peer support duration with the best metabolic effectiveness was >3 and ≤ 6 months. 224 Chapter 9