Background
Methods
Search strategy and study selection
Data sources
Quality assessment
Data extraction
Data synthesis and analysis
Results
Study selection
Study name, year published | Study duration in months | Sam-ple size | Country, Population | Baseline care for intervention and control group | Intervention | Cardiovascular health metrics measured |
---|---|---|---|---|---|---|
Keyserling, 2002 [34] | 12 | 133 | U.S: African-American women | Four individual counseling visits with nutritionist | Peer-delivered three group sessions and monthly telephone calls from a peer-counselor for 12 months. Peer supporter training duration: 16 h | Total cholesterol Weight Diet: calories from saturated fat, dietary cholesterol, total energy intake Physical activity measured by accelerometer |
Lorig, 2008 [44] | 6 | 417 | U.S: Spanish-speaking patients | Usual care | 2.5 h weekly sessions led by two peer leaders for 6 weeks. Peer supporter training duration: 24 h | Physical activity: exercise minutes per week |
Lorig, 2009 [45] | 6 | 345 | US: White, non-Hispanic 67% | Usual care | Peer leader delivered 2.5 h weekly sessions for 6 weeks. Peer supporter training duration: 24 h | Physical activity: exercise minutes per week Weight |
Cade, 2009 [29] | 12 | 207 | U.K: White, European origin 95% | Usual care | 2-h education sessions per week for 7 weeks by peer educators. Residential peer supporter training mentioned without hours | Systolic Blood pressure Diastolic Blood pressure Total Cholesterol BMI Diet: energy, protein, fat, fiber and fruit and vegetable intake |
Heisler, 2010 [46] | 6 | 244 | U.S.: Male veterans white non-Hispanic 82% | Usual care | Weekly calls encouraged between peer partners. Optional 1.5 h face-to-face sessions at 1, 3, and 6 months. Peer supporter training duration: 1.5 h | Systolic Blood pressure Diastolic Blood pressure |
Philis-Tsimikas, 2011 [47] | 10 | 207 | US.: Mexican Americans | Usual care | 2.5-h weekly education sessions by peer educators for 8 weeks. Peer supporter training duration: 40 h | Systolic Blood pressure Diastolic Blood pressure Total Cholesterol LDL cholesterol BMI |
Smith, 2011 [30] | 24 | 388 | Republic of Ireland: 50% of the population was low income Ireland general demographics 94.3% White non-Hispanic | Usual care | Peer-supporter facilitated sessions over 2 years; at month one, month two, and every 3 months thereafter (total nine sessions). Peer supporter training duration: 6 h | Systolic Blood pressure Total Cholesterol BMI Smoking Summary of self-care activities (SDSCA): scale to measure diet and physical activity |
Gagliardino, 2013 [48] | 12 | 198 | Argentina: Hispanic, Non-minority in country of residence | Five 90-120 min sessions with diabetes educators | Initially weekly peer educator sessions of 90–120 min for 4 weeks; one at 6 months followed by weekly calls for 6 months then biweekly calls for 3 months. Additional face-to-face visits with peer supporters were scheduled every second month if specific issues warranted. Peer supporter training duration: 3-day training course | Systolic Blood pressure Diastolic Blood pressure Total Cholesterol BMI |
Siminerio, 2013 [31] | 6 | 68 | U.S.: > 80% White non-Hispanic ethnicity | Certified diabetes educator delivered diabetes self- management education for 6 weeks | Monthly peer calls for 6 months Peer supporter training duration: 2–3 h | Systolic Blood pressure Diastolic Blood pressure Total Cholesterol LDL cholesterol BMI Summary of self-care activities (SDSCA): scale to measure diet and physical activity |
Thom, 2013 [49] | 6 | 299 | U.S: Hispanic 46.65% and African American 31.25% | Usual care | Telephone contacts with peers at least twice a month and 2 or more in-person contacts in 6 months. Peer supporter training duration: 36 h | Systolic Blood pressure LDL cholesterol BMI |
Chan, 2014 [32] | 12 | 628 | China: 100% Chinese speaking | Two-hour nurse-led empowerment class and personalized, comprehensive assessment report to all participants at baseline and follow-up | Peer supporter phone calls biweekly for 3 months, then monthly for 3 months, and then 1 call every other month for 6 months; anticipated 15 min per call Peer supporter training duration: 32 h | Systolic Blood pressure Diastolic Blood pressure Total Cholesterol LDL cholesterol BMI Weight; Waist Summary of self-care activities (SDSCA): scale to measure diet and physical activity |
Simmons, 2015 [50] | 12 | 644 | England: Cluster randomized factorial design > 90% white,non-Hispanic | Usual care | Peer-led group education sessions once a month for at least 5 months and telephone/email for 1:1 counseling Peer supporter training duration: 17.5 h | Systolic Blood pressure Diastolic Blood pressure Total Cholesterol Weight; Waist |
Safford, 2015 [51] | 15 | 424 | US: Cluster randomized trial > 90% African Americans | One diabetes group education class with 5 min of individual counseling with diabetes report card. | Initial 45–60 min in-person or telephone get to know session with peer supporter followed by weekly calls for 2 months followed by monthly calls for 8 months Peer supporter training duration: 12 h | Systolic Blood pressure LDL cholesterol BMI |
Ayala, 2015 [33] | 12 | 336 | US: Predominantly Hispanic | Usual care | 8 telephone or in-person contacts with peer supporter in first 6 months, then as needed contacts in the last 6 months. 92% of participants had telephone contacts. Peer supporter training duration: 40–50 h | Systolic Blood pressure Diastolic Blood pressure SDSCA to measure diet and physical activity |
McGowan, 2015 [52] | 12 | 361 | Canada: Ethnicities not mentioned | Usual care | Peer-led self- management programs with varying components: weekly meetings for 6 weeks Peer supporter training duration: 24 h | Systolic Blood pressure Diastolic Blood pressure LDL cholesterol BMI Weight |
Sazlina, 2015 [53] | 8 | 46 | Malaysia: Asian, urban primary care clinic in Selangor, Malaysia | Three sessions providing personalized feedback about participant’s physical activity patterns | Peer supporters had three face-to-face and three telephone contacts over the 12 weeks. Peers motivated and provided support to the participants to walk regularly Peer supporter training duration: 2-day training program | Systolic Blood pressure Diastolic Blood pressure LDL cholesterol BMI Physical activity measured by pedometer |
Risk of Bias and publication Bias
Peer support effect on blood pressure
Outcome | Number of studies | Pooled effect size (SMD)a | 95% CI | Baseline pooled mean | Pooled effect size in original metric | 95% CI in original metric | p-value for SMD | I
2
(%) | Publication bias: p-value of Egger Regression test |
---|---|---|---|---|---|---|---|---|---|
Systolic Blood pressure | 12 | 0.107 | 0.018 to 0.195 | 137 mm hg | 2.07 mm hg | 0.35 to 3.79 mm hg | 0.02 | 34.47 | 0.15 |
Diastolic Blood Pressure | 9 | 0.039 | −0.086 to 0.164 | 77 mm hg | 0.42 mm hg | −0.94 to 1.79 mm hg | 0.5 | 49.08 | 0.6 |
Total Cholesterol | 8 | 0.058 | −0.022 to 0.138 | 181 mg/dL | 2.61 mg/dL | −0.99 to 6.21 md/dl | 0.1 | 0.00 | 0.2 |
LDL cholesterol | 5 | −0.008b | −0.124 to 0.109 | 107.85 mg/dl | - 0.28 mg/dl | −4.41 to 3.87 mg/dl | 0.8 | 8.47 | 0.2 |
BMI | 9 | 0.017 | −0.071 to 0.104 | 31.27 | 0.11 | −0.48 to 0.7 | 0.7 | 0.00 | 0.9 |
Physical activity | 8 | 0.019 | −0.068 to 0.106 | N/Ac | N/Ac | 0.6 | 0.00 | 0.07 |