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BACKGROUND: The effects of medication nonadherence are especially profound in remote, economically depressed communities with a high burden of chronic diseases, such as the rural Alabama Black Belt region. We built on our previous work in this region to rigorously test a community member-delivered intervention designed in partnership with community peer coaches. SPECIFIC AIMS: With our community partners, using qualitative research methods, we developed a medication adherence intervention delivered by trained community members (aim 1) and then tested this intervention in a cluster-randomized trial of individuals with diabetes seeking help with adherence to their medications (aim 2). METHODS: We first conducted qualitative research with experienced peer coaches and community members to learn their perspectives on diabetes and the medications used to treat it. Using this information, the Corbin and Strauss framework of the lived experience of illness, Bandura's social cognitive theory, and adult learning theory, we developed an 11-session telephone-delivered diabetes self-management intervention that stressed medication adherence, assessed barriers to adherence, and involved strategizing to overcome these barriers. The intervention, delivered by community peer coaches, also provided information on healthy eating, physical activity, and stress reduction, and encouraged communication with health care providers. We then conducted a cluster-randomized trial, using towns as clusters, to test the effectiveness of this intervention. The intervention was deployed by trained peer coaches who resided in the same communities as the participants. We collected baseline and 6-month follow-up data in the communities where participants were recruited. The primary outcomes were self-reported medication adherence and measures of hemoglobin A1c, blood pressure, low-density lipoprotein cholesterol, and body mass index. Secondary outcomes were quality of life (QOL), medication beliefs, and self-efficacy to use medications. RESULTS: We recruited a total of 473 participants, 403 of whom completed follow-up (85.4% retention), which was within the design specifications for the study. The mean age of the trial population was 57.2 years, 78.2% were women, 90.6% were African American, 69.3% reported an annual income of < 20 000, 26.7% were employed, and 43.8% were taking insulin. In the control arm, 239 (89%) participants completed the study, and in the intervention arm, 164 (81%) completed the study. The intervention dose was high, with 81.8% of intervention participants completing all 11 sessions of the program. Self-reported medication adherence improved more in the intervention arm than in the control arm (P < .0001), but the other primary outcomes did not differ significantly between the trial arms. QOL improved similarly across both trial arms, but beliefs about the need for medications, concerns about medications, and medication use self-efficacy improved more in intervention than in control participants. Satisfaction with the program was high. CONCLUSIONS: This intervention was highly engaging and improved self-reported medication adherence and self-efficacy, but it did not improve glycemic control or other physiologic parameters among mostly African American individuals desiring help with their diabetes medications and living in a remote, economically disadvantaged rural region. LIMITATIONS: Real-world challenges created delays in data collection, which may have influenced the study results. The self-reported availability of healthy foods was limited, possibly limiting dietary changes recommended in the intervention, such as increasing the consumption of fresh fruits and vegetables. The intervention was entirely community based and without a clinical component; thus, medication titration to achieve better glycemic control was not included as part of the intervention and may have limited the intervention's impact on physiologic parameters. The fact that the study was restricted to the Black Belt setting may limit the generalizability of the findings.

Black people. --- Community participation.

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Les médias grand public financés par l’industrie pharmaceutique ont convaincu des millions d’Américains que le Dr Anthony Fauci est un héros. Or, il est tout sauf un héros. En tant que directeur de l’Institut national des allergies et des maladies infectieuses (NIAID), le Dr Anthony Fauci distribue chaque année 6,1 milliards de dollars d’argent public à la recherche scientifique, ce qui lui permet de dicter le sujet, le contenu et les résultats des études sur la santé humaine dans le monde entier. Fauci utilise la puissance financière dont il dispose pour exercer une influence extraordinaire sur les hôpitaux, sur les universités, sur la presse médicale et sur des milliers de médecins et scientifiques de premier plan – il a le pouvoir de ruiner ou d’accélérer leurs carrières, de les récompenser, et tient entre ses mains le destin des institutions au sein desquelles ils exercent. Pendant plus d’un an de recherches fouillées et méticuleuses, Robert F. Kennedy, Jr. a mis au jour une histoire choquante qui réduit à néant le battage médiatique à propos du Dr Fauci… et qui alertera tous les Américains – démocrates comme républicains – attachés à la démocratie, à la Constitution des États-Unis et soucieux de la santé de nos enfants. Anthony FAUCI, Bill GATES et Big Pharma, révèle comment le « docteur de l’Amérique » a lancé sa carrière au début de la crise du SIDA, en s’acoquinant avec des sociétés pharmaceutiques pour saboter des traitements thérapeutiques sûrs et efficaces contre le VIH. Fauci a orchestré des études frauduleuses, puis a fait pression sur les agents de la Food and Drug Administration (FDA) pour qu’ils approuvent un traitement de chimiothérapie mortel qu’il savait pertinemment être sans valeur contre le SIDA. À maintes reprises, Fauci a violé des lois fédérales pour permettre à ses copains de l’industrie pharmaceutique d’utiliser des enfants pauvres et à la peau foncée comme des rats de laboratoire, dans le cadre d’expériences fatales impliquant des chimiothérapies toxiques contre le SIDA et le cancer. Au début des années 2000, à Seattle, Fauci et Bill Gates ont topé dans la bibliothèque du manoir de ce dernier (d’une valeur de 147 millions de dollars), scellant un partenariat qui visait à contrôler une entreprise planétaire de vaccins, au capital de 60 milliards de dollars, de plus en plus rentable et au potentiel de croissance illimité. Aujourd’hui, grâce au levier d’action du subventionnement et à des relations personnelles soigneusement entretenues avec des chefs d’État, des patrons de grands médias et de réseaux sociaux, la triade Big Pharma-Fauci-Gates domine la politique mondiale en matière de santé. Anthony FAUCI, Bill GATES et Big Pharma, détaille la façon dont Fauci, Gates et leurs acolytes exploitent leur emprise sur les médias, sur les revues scientifiques, sur les entreprises publiques et parapubliques clés, sur les agences internationales de renseignement et sur les scientifiques et médecins influents pour à la fois inonder la population d’une propagande effrayante sur la virulence et la pathogenèse de la COVID-19, museler le débat et censurer férocement les voix dissidentes.

Medical policy --- Pharmaceutical industry --- Business community participation

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Health --- Consumer Advocacy. --- Community Participation. --- Consumer Behavior.

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Community participation --- Doctrines politiques --- Citoyennete --- France --- Community participation --- Doctrines politiques --- Citoyennete --- France

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Health --- Consumer Advocacy. --- Community Participation. --- Consumer Behavior. --- Health.