Rebecca Rude Ozaki, PhD Thomas W. Christ, PhD Jean Isip Schneider, MEd, SPHR

1. Diabetes Intervention and Employment: A Randomized Controlled Mixed Methods Study Rebecca Rude Ozaki, PhD Thomas W. Christ, PhD Jean Isip Schneider, MEd, SPHR 2010 U.S. Public Health Service Scientific and Training Symposium May 26, 2010 San Diego, CA

2. Presentation Outline Learning Objectives Motivating Factors Mixed Methods approach & study design Participant profile Intervention component usage Preliminary results and implications Study limitations Recommendations and next steps

3. Learning Objectives Articulate the different methods used to evaluate the data. Describe the different aspects of the DMIE Live healthy…Work well research design, intervention. Describe the preliminary results and implication for future research

4. Motivating Factors

5. Demonstration to Maintain Independence and Employment (DMIE) National Evaluation Mathematica Policy Research, Inc (MPR)

6. Mathematica Policy Research, Inc (MPR) To learn more about the Demonstration to Maintain Independence and Employment Projects please go to: • http://mathematica-mpr.com/ • http://mathematica-mpr.com/disability/dmie.asp

7. Overarching DMIE Research Question Can a program of Life Coaching, Pharmacist Counseling and other supports forestall or prevent the loss of employment and independence due to a potentially disabling and medically determinable chronic condition – Diabetes?

8. Quantitative Hypotheses There will be a difference in outcomes between the intervention and control group in the following areas: 1) Improved health status 2) Continued employment 3) Maintain independence from SSI/SSDI

9. Quantitative Measures

10. Qualitative Research Question What are the participant’s perceptions of the value, usefulness, and challenges of a person-centered program designed to improve health and employment.

11. Qualitative Data Collected & Analyzed

12. Data Merging • Quantitative and qualitative data strands collected and analyzed concurrently • Each strand analyzed separately • Results from the strands compared and merged (triangulation)

13. Study Design: Experimental

14. Intervention Components Control Group received Usual Care, reimbursements for health assessments, and incentives for completion of evaluation surveys.

15. Eligibility Criterion • Diagnosed with diabetes or HbA1c ≥ 6.5 • Between the ages of 18 – 62 • Live on the island of O`ahu in Hawaii • Work at least 40 hours per month at the federal minimum wage or higher • Not receiving Supplement Security Income or Social Security Disability Insurance

16. Study sample was fairly healthy and well employed at baseline Participants: Baseline

17. Most participants had good to moderate control of their diabetes Participants: Diabetes Management < 7 7 - 9 > 9

18. Study sample is ethnically diverse Other : Mixed or non-NHPI, Black, Other, AIAN Participants: Diverse Other Asian: (Filipino, Chinese,Other Asians)

19. Intervention: Service Usage Life Coaching was the dominant intervention component accessed.

20. Quantitative Data

21. Diabetes self efficacy and body mass index changes were significantly better in the treatment than the control group. Results: HEALTH

22. Diabetes Self-efficacy* p<.001 * Score on the University of Michigan Diabetes Empowerment Scale – Short Form (DES-SF)

23. Body Mass Index p<.001

24. No significant differences between treatment and control groups. Results: DISABILITY & EMPLOYMENT * Five programs tracked: Temporary Assistance to Needy Families, Food Stamps, Section 8 or other subsidized housing, Medicaid, Vocational Rehabilitation.

25. Qualitative Data

26. Satisfaction - Life Coaching:12 months N=93 Scale: 1 = Completely Dissatisfied; 4 = Completely Satisfied

27. Overall Satisfaction with Life Coaching - 12 months Completely Dissatisfied Completely Satisfied 1 2 3 4 N = 93 3.80

28. Feedback about Life Coaching “Coaching allows me to share concerns about other aspects of my life which affects the way I deal with my health.” “I was lucky to get a life coach, so it’s good because when I was diagnosed, it seemed like this huge thing and she helps me break it down so that there are little goals along the way, so that I’m not looking at it as an insurmountable mountain.” Fukunaga, L . et.al. Live Healthy Work Well Research Brief #2

29. More about Coaching “Over the past 12 months, my participation in the program has definitely affected the management of my diabetes in the sense that it went from pretty much zero to actually something…. I believe that the aspect of the project that brought about the changes specifically was the life coach.”

30. Satisfaction with Pharmacist Counseling - 12 months N= 85: Scale: 1 = Completely Dissatisfied; 4 = Completely Satisfied

31. Overall Satisfaction with Pharmacist Counseling – 12 months Completely Dissatisfied Completely Satisfied 1 2 3 4 N = 86 2.97

32. Feedback about Pharmacists “Meeting with my pharmacist, being able to describe to her what kind of medication I’m on, what kind of diet I’m on, and getting her feedback of what I need to stay on top and how to go about doing it and getting her support as well. That I can do it.” Uehara, D. Fukunaga, L. (2010) AERA Slides

33. Participant Feedback • HELPFUL: • Being held accountable • Goal setting • One-on-one communications/discussions • Diabetes and nutrition information from service providers

34. Participant Feedback “I think this program that I just completed with the University was very helpful because it had a pharmacist, it had a dietician, and it had a life coach, and all three of them were really able to help me out on a regular basis.” “I mean I really feel empowered… I think this program was very positive. It really helped me learn about my goals and… what are my options and just to think about like alternatives…. So this is the thing you want to achieve, if you cannot achieve it, then say what are the different alternatives you can use.”

35. Preliminary Implications THE INTERVENTION: • Increased diabetes self efficacy • Improved health • More effective for those with poor chronic disease management skills FUTURE RESEARCH • Informs federal legislation for potential policy and funding options • Adds to the literature for future community-based person centered approaches for adults with chronic illness

36. Study Limitations 1. Limited access to some intervention components • Some support services were a more difficult to access than others • Might have influenced usage 2. Limited intervention and tracking period • Difficulty detecting changes over time • Unlikely to see disability enrollment 3. Small sample size

37. Recommendations • Study cost effectiveness of life coaching and pharmacist counseling • Integrate into health initiatives • Future interventions • Face-to-face: one-on-one support (engagement) • Use of goal setting and personal accountability

38. 1. Data Collection Through June 2010 2. Analysis & reporting Measure effects of treatment on Employment Health Access to government benefits Final report – September 2010 3. Intervention components Life Coaching Pharmacist Counseling

39. Project Team (current and former members) • Mary Lou Matsuura • Adela Mearig • Nani Picerno-Manrique • Chin-Chin Minniear • Corrie Ota • Rebecca Rude Ozaki – PI • Kathy Richins • Crystal Watanabe • Denise Watanabe • Patrick Yrizarry • Brandon Arakaki • Calvin Cheung • Thomas Christ • Kriste Colley-Valdez • Kevin Dierks • Sreang Heak • Junko Hashizume • Jean Isip Schneider • Courtney Johnson • Dongmei Li • Lisa Maetani

40. Independent Evaluation Team (current and former members) • Christy Nishita • Alice Tse • Tammy Tom • Denise Uehara – Coordinator • Monica Um • Marisa Watanabe • Evaluation Advisory Council • Just Your Type • UH CRDG • Gina Cardazone • Rebecca Chelliah • Rochelle Dulatre • Sara Fares • David Francis • Landry Fukunaga • LeeAnna Kobayashi • Natalya Mekkoyeva • Mizuho Murakami

41. Our Community • HECO • Roberts Hawaii • Servco Pacific • University Health Alliance • Quality Assurance Committee • American Diabetes Association – Hawaii Chapter • Project Advisory Council • Centers on Medicare & Medicaid Services • HI Department of Human Services • HI Department of Health • Mathematica Policy Research, Inc. • Hawaii Business Health Council • Times Supermarket • Longs Drug Stores

42. Mahalo… Thank you! Contact information: Becky Ozaki rozaki@hawaii.eduJean Isip Schneider isip@hawaii.eduThomas W. Christ tchrist@hawaii.eduTammy Tom tmytom@hawaii.eduProject website:http://www/manoa.hawaii.edu/livehealthy/