This unique pre-post group study tested the feasibility and acceptability of the 16-week peer educator training component of the HOPE intervention. The study was approved by the university’s social science human subject protection committee and participants provided written informed consent prior to any study procedures.
Any woman who identified as African American was eligible to participate in the training program if she was 40 or older and identified as the primary caregiver for one or more grandchildren between the ages of 2 and 18. A primary caregiver has been defined as “one who provides instrumental and expressive care to a grandchild living in the same household on a daily basis for an indefinite period of time.”  Additionally, women interested in becoming peer educators had to meet eligibility criteria to participate in the DPP, including: (1) being overweight or obese (BMI ≥ 25 kg/m2); (2) no previous diagnosis of diabetes; 3) and a glycosylated hemoglobin A1C between 5.7 and 6.4% . The grandmother must be willing to complete a demographic questionnaire and two validated surveys that assess physical activity and eating behavior.
The grandmother must be willing to be weighed at study enrollment and at the end of the study period as well as attend weekly DPP training sessions to the extent of her ability. Grandmothers were excluded if they were pregnant or had illnesses that would limit their lifespan or restrict their ability to participate in the study.
We recruited 30 women from two community centers located in ethnically diverse neighborhoods in Wisconsin. Staff at each community center were asked to identify 15 women they thought would be good peer educators for the HOPE Peer Educator Training. In addition to meeting the inclusion criteria listed above for grandmothers, desirable characteristics and attributes of a peer educator included being actively engaged in community activities, being willing and available to be trained and participate in the DPP+HOPE subsequent intervention, have good interpersonal skills, possess similarities to target participants, be respected in the community, have the ability to motivate others, have good listening skills, have basic resolution skills problems, live in the community served and be willing to help the community.
Peer support training
Grandmothers were required to participate in a 32-hour DPP training program. The training program schedule is flexible. The training program can be offered in its entirety over 4 consecutive days for trainees who prefer a concentrated or spread out experience over a period of 2 to 16 weeks. The HOPE training program was offered 2 hours per week over 16 weeks to accommodate participants’ schedules.
The sessions, led by a specialist in diabetes care and education, encouraged healthy eating, increased physical activity, modest weight loss (5%) and reduced hemoglobin A1C. The sessions also covered the role of the peer educator, which included empathetic listening and helping participants develop health goals for themselves and their family members. These training sessions were guided by the DPP training manual and a peer support training manual and toolkit focusing on supportive and non-judgmental communication, goal setting, motivational interviewing and providing social and emotional support. Grandmothers were also required to undergo training in human participant research (IRB) ethics.
We assessed the feasibility of the training program by noting the number of participants recruited and retained in the program. We also conducted open-ended interviews during the last week of the program to learn about each participant’s experience during the training sessions. The 30-minute interview was conducted by a member of the study team who did not participate in the training sessions to encourage honest feedback. Based on our previous work , we asked participants to share their views regarding: (a) beneficial or useful aspects of the program; (b) problems or difficulties encountered during the program; (c) recommendations for improving the program; and (d) whether they would recommend the program to a friend. The interviews were audio recorded and transcribed. Participants who dropped out of the program were interviewed by telephone to find out (a) why they left the program, (b) what aspect of the program they liked or disliked, and (c) recommendations for improving the program . .
A digital electronic scale (Conair Body Analysis Weight Tracker Scale Model CON WW89T) was used to measure the body weight of each participant. Each grandmother’s weight was obtained with the woman in a standing position, barefoot and wearing light clothing. Physical activity and dietary behavior were assessed at enrollment and at the end of the 16-week training period using two validated surveys: the International Physical Activity Questionnaire (IPAQ)  and the food frequency questionnaire . The IPAQ estimates levels and frequency of physical activity over the past 7 days, and the Food Frequency Questionnaire contains questions about the usual intake of various food groups [30, 31].
Hemoglobin A1c was assessed at baseline to determine eligibility to participate in the study  and termination of the study to determine if the participant has progressed to diabetes. We used the A1cNow+ System, the CLIA-exempt National Glycohemoglobin Standards Program-certified system that provides results using a fingertip test.
The authors carefully read the transcripts of each interview to gain an understanding of the data. Analysis of the interview transcripts used a conventional content analysis approach , where each transcript was hand-coded with notations to delineate a basic description for each idea. The principal researcher (first author) and co-researcher (second author) coded independently, then met to discuss their impressions and reach consensus on the overall meaning of the content. Finally, the authors identified common themes that emerged from the content analysis.
Since the data were slightly skewed, the Wilcoxon Sign Rank test was used to assess changes in body weight, physical activity, and fruit and vegetable consumption between baseline and week 16. All analyzes were performed using SAS (SAS Institute Inc, Cary NC).