Thank you for your inquiries regarding the Call for Proposals. The questions we receive will be consolidated, answered, and posted on an on-going basis.
It is anticipated that six to eight Evaluation Grants will be awarded with total costs ranging from $500,000 to $1 million per grant. These total costs will include 18% overhead allowed by the American Academy of Family Physicians Foundation. Evaluation Grants will begin on or about January 1, 2009.
Evaluation Grants will be implemented over an 8-month development phase and a 2-year implementation phase (for a total of 32 months). During the 8-month development phase, grantees will work with other grantees to establish shared protocol features and demonstrate the feasibility of recruitment, implementation of interventions, and evaluation protocols within their settings. Contingent on demonstration of ability to implement their protocols, grantees will be provided an additional two years of funding during which they will collaborate with each other and Peers for Progress leadership to complete an evaluation of peer support in diabetes care. Please note that the initial award will be made with the full expectation that all those receiving awards for the initial, 8-month period, will go on to receive funding for the following, 24-month implementation phase.
Below please find a series of Frequently Asked Questions (FAQs) and Answers related to development of Peers for Progress Evaluation Grants. These include previously posted questions as well as those addressed through two recent Webinars held July 28 and 29. You can download and view the recent webinar presentation and corresponding talking points for more information.
As listed, these FAQs are organized under six basic themes:
1) Applicant Criteria (AC)
2) Budget (B)
3) Evaluation Approach (E)
4) Intended Audience/Setting (IA)
5) Peer Support Intervention (PS)
6) General/Other (G)
Click on the appropriate section link above to view all the FAQs and Answers in that section. You can also scroll through the questions listed below and click on a particular question to see that response.
Please refer to these FAQs before contacting Peers for Progress as your questions may be addressed here. Also, please refer to http://www.peersforprogress.org/proposal/announcements.html to review Program Development Center review comments based on brief proposals submitted July 1, 2008. For further clarification or other questions, please email PfP@unc.edu.
APPLICANT CRITERIA (AC)
AC1. Can we submit an application with two Co-Principle Investigators (PIs)? My colleague and I would like to submit to this call together as we work in parallel with two different populations. We would like to propose an intervention using both populations.
AC2. Are Co-PIs allowed/acceptable?
AC3. Do potential grantees need to have a diabetes self-management intervention or program, intended to be delivered by peers, prior to applying for funding? Or will a program or intervention be developed for peers by the grantees and others during the development phase?
AC4. Your proposal has asked that we describe an "applicants' experience in development and evaluation research." I am a bit confused given that the proposal will be developed by staff members from three separate community based organization, one staff from an educational institution, and myself. How do I decide who is the lead person if we want this to be a team effort? If I include all of them, then my next concern would be the proposal length requirement.
AC5. Could you please provide more detail about what you mean by “experience in research and program evaluation?”
AC6. When you ask about experience with collaborative research, does working with different departments in the same institution qualify?
AC7. Are Diabetes Prevention and Control Programs within state health departments in the US or other government based groups eligible for these grants? Are non-governmental organizations or community based organizations eligible to apply?
AC8. Does the fiscal agent have to be an academic institution?
BUDGET (B)
B1. In cases in which a grant includes components in several institutions and, perhaps, several countries, how should budgets be arranged? Should they be arranged as separate grants or as subcontracts within one "parent" grant? How is overhead handled in such cases?
B2. Is there a specific format for the budget?
B3. Do we need to budget for translation or is the material for the ethnic group to be targeted?
B4. May we pay full-time peer mentors?
B5. Is it acceptable to budget stipends for or pay full-time peer mentors?
B6. Can the people who are giving the support be a combination of volunteer and paid, or should they all be volunteers?
B7. Is there a limit to the kind and amount of financial support we can provide to our volunteers providing peer support? Can we provide a small amount of support as appreciation for their involvement? Can we reimburse them for time involved in their training? Can we reimburse them for their expenses?
B8. Can grantees provide transportation?
B9. In today’s environment of escalating costs, especially gasoline, can we provide vouchers for participants of diabetes to defrayed travel costs?
B10. Our work with community health workers (CHWs) has included salaried, paraprofessional peer educators as CHWs. Is this model responsive to the call for proposals? Since there is much discussion and little evidence on the relative merits of the lay/volunteer and paid/staff models, PfP could be in a good position to shed some light on this important question if both types of models were included.
B11. If we feel that our peer support model proposes an innovative approach with potential broad impact, would it be better to propose a more modest budget for this grant or is it scalable – is scalability a priority at this point?
B12. Will grantees need to include travel costs to attend Peers for Progress meetings?
B13. Is there support for meetings that the grantees will need to attend that should be included in the budget?
B14. How much travel is anticipated for the first eight months for collaboration, or is travel indicated for dissemination of findings only? How much travel may be involved and to what locations?
B15. If sites are implementing an innovation and comparing it to conventional care as part of an existing service line, can the site still receive payment for the service even though the patient is joining a research study, i.e., physician care for diabetes care? Can we still expect and/or accept payment from insurance for conventional care and use the research funds to offset the innovative elements of the trial?
B16. Can there be a component in the budget for training the peer mentors on the diabetes self-management plan and the diabetes national standards?
B17. Is point of service A1C or (lipid tests) handheld machine is allowable in the budget?
B18. Can the program pay for resources such as glucose test strips in systems where patients have little access to them?
EVALUATION (E)
E1. In looking over the information regarding the calls for proposals for the evaluation grants, it is hard to tell whether grantees will evaluate existing programs or will create a program and evaluate it. Can you please clarify?
E2. The Call for Proposals indicates that funded projects “will use controlled research methodologies to study and document the contributions of peer support interventions for those with diabetes” (Call for Proposals, p. 2). Can you say more about what “controlled research methodologies” might be fundable?
E3. What kind of controlled research design are you interested in?
E4. Is there a preferred study methodology, e.g., randomized control trial, cohort study?
E5. I read in yesterday’s material that you were not requiring the evaluation to be in the form of a randomized control trial. Is that still if your preferred method, if feasible?
E6. How would a randomized geographical cluster Controlled Trial of peer support fit into the joint international approach? Although we think we could do this with adequate power in our areas to test the efficacy of peer support with minimal contamination, would this fit into the evaluation approach you were thinking of?
E7. We are considering a wait list design - is it necessary for this grant?
E8. Can you give more advice on the controlled study design? Should it be a randomized control trial? Would a qualitative evaluation and analysis of intervention using focus group surveys and video analysis be welcome?
E9. Note on Evaluation of Program Reach
E10. How many participants should be included to make this a feasible study?
E11. Would we use common questionnaires/evaluation tools? If so, do we include a description of tools in any application?
E12. To what extent will measures and instruments be agreed upon and shared between projects?
E13. Since funded grants will be asked to use common evaluation instruments and measures, should proposals include outcome measures and process measures?
E14. Is there an expectation that we should collect blood work from peers as part of the evaluation?
E15. Is the interest primarily on glycemic control or is blood pressure and lipid control also considered part of metabolic control?
E16. Is anybody considering using a psychosocial outcome measure?
E17. How much emphasis is being placed on changes in the peer supporters, either physiological or psycho social versus the actual participants?
E18. Is it expected that we should build in time following the intervention period to complete the evaluation and analysis?
E19. Will our final evaluation report be due during the funding period? Or within a specified time period after the funding period?
E20. What do you consider long-term follow-up? One year, two years, multiple years, a lifetime?
E21. Is there a minimum period of follow-up that is a requirement?
INTENDED AUDIENCE/SETTING (IA)
IA1. Is the Peers for Progress Evaluation Grant allowed to address non Medicare beneficiary adults?
IA2. Is Peers for Progress only geared toward diabetes or does it include other illness groups?
IA3. Are proposals addressing children and youth appropriate for Evaluation Grants?
IA4. We work with youth – empowering youth to act as agents for change in South America with the diabetes community, but our work has been mainly concentrated on type I diabetes. Do you think this would be acceptable as part of this study?
IA5. What about special needs or populations among those with diabetes, such preconception counseling or those with specific problems associated with diabetes such as blindness, amputations, or depression?
IA6. Because a significant portion of the mentally ill population is affected by diabetes, especially due to the effect of psychotropic medications, would they be viewed as an eligible population or be considered special needs and therefore ineligible? Our intention would be to draw upon the documented success of the mental health recovery movement in delivering consumer-driven peer supports and services in the United States and explore our share of best practices that can be applied to the population at large.
IA7. Is addressing a population with pre-diabetes or focusing on diabetes prevention within the scope of this grant?
IA8. I asked a question about pre-diabetes, and I just wanted a clarification on the answer. So if we were to target a population at risk for diabetes with diabetes prevention activities around behavior change and it did not specifically deal with diabetes management, then that would not be what you are looking for, is that correct?
IA9. We worked with not only people with diabetes, but their families, and we also worked with older patients who may be mentally compromised. How much of (this) can we do as far as people who do not have diabetes but who are at risk or are caregivers of people who have diabetes? Can we include them, and if so, how?
IA10. Do you have a view on when a program should address both Type I and Type II diabetes, or can we focus on Type II because we envision that group support will work better if we are including people with the same type of diabetes?
IA11. Would Peers for Progress prefer proposals to focus on clinical settings as opposed to non-clinical settings such as educational settings?
IA12. What importance will the grant review process attach to how the framework and design of the project will be applicable to other sites, regions and countries?
PEER SUPPORT INTERVENTION (PS)
PS1. We are wondering if, for the purposes of this RFP, we might be able to cast medical students as peers providing support for patients with diabetes--or even, could we cast patients with diabetes as peers with medical students.
PS2. How exact is the definition of peers?
PS3. Would you consider diabetes educators and/or CDEs (certified diabetes educators) to be peer mentors?
PS4. Can peer mentors be employees of a community-based organization or must they be volunteers?
PS5. This question is driven more by curiosity versus information seeking. Besides wanting to inform the development of programs with greater potential of sustainability, compared with most lay health assistant interventions, what prompted the committee to want to test the volunteer model?
PS6. Is the expectation that peers will themselves have diabetes? Or can they be members of the target communities?
PS7. We have considered an intervention using a mix of medical assistants from the office as well as patients. Is it a requirement that mentors have diagnosis of diabetes?
PS8. Do you have any expectation of a certain number of participants to be involved as mentees or mentors?
PS9. Are there guidelines for the ratio of lead peers to peers?
PS10. Does the definition of a peer support program include group based peer support in a clinic setting? Does it include the peer support in shared group medical appointment visits?
PS11. What about support groups?
PS12. May I propose a common [intervention] protocol to follow for all those who may be interested to the studies on the subject? Maybe the different sites may just introduce variations based on what can be done in their areas?
PS13. Is it the case that applicants will submit proposed peer support interventions, but that the actual intervention will be developed by the group of chosen investigators so that all sites will do the same intervention?
PS14. To what extent do you anticipate applicants will work together if funded and adapt the way that we develop and deliver the peer support interventions after decisions on funding? To what extent will approaches be developed in common, and to what extent will we be developing our approach as separate projects?
PS15. Please comment on the strength of an application regarding rigorous statistical control versus creative and/or tailored interventions.
PS16. There is already a curriculum for diabetes education of the International Diabetes Federation (IDF). Will this be used as a template for the train-the-trainer or expert people with diabetes to provide peer support? Or will an independent curriculum be developed by the group?
PS17. For institutions where patients are all linked to the healthcare system, how do we specifically address linkage to clinical care?
PS18. Can you talk a bit about the level of responsibility you have in mind for grantees with regard to linkage to clinical care?
PS19. What do you mean by intervention?
PS20. Is the model of peer support for diabetics inspired by and similar to the models of narcotics anonymous), etc?
PS21. Do we have to have the curriculum completely written at the time of submission? Or can the first eight months be used for this?
PS22. Can we consider the first eight months of the grant as a pilot testing phase in which we later can define and refine the intervention and evaluation – before implementation for the next two years?
PS23. Can you use an already-established evidence-based best practices and intervention, or are you required to develop a new intervention?
PS24. Given that the underlying purpose of this grant is to build evidence for peer support, is it OK to propose a novel innovative first-time approach? While we would rely on our experience, we’d like to target a new audience in a specific setting that has its own infrastructure for sustainability.
PS25. In reviewing the call for proposals, there were several links to the (WHO) report and well-tested interventions. For the purpose of this evaluation grant, can I use those methods but demonstrate how effective it would be with my populations (Southern minorities and financial challenges)?
PS26. In recent communication, you mentioned the importance of long-term support, yet we have found that getting volunteers involved requires specifying a given time frame for their involvement. If we specify a given time frame for their involvement, are we shooting ourselves in the foot?
PS27. I have a question about a comment that was made earlier about the expectation that there's a very long-term involvement of the programs that we're defining for our grants. The understanding that I got was that the expectation is that it's not just a short or delimited term intervention or program, but in fact, it's something that goes across a considerable life course of the individual.
PS28. Can you clarify the recommendation we receive to propose ongoing long-term support for the proposed peer support interventions? Many programs have specific time-defined intensive educational interventions, especially during initial diagnosis of a hospital discharge.
PS29. Given the period of the grant, eight months planning phase, 24 months implementation phase, is there a preferred length of participation for subjects?
PS30. Follow-up question about the breadth and focus of the nature of the peer support.
PS31. Can you give some examples of what you would consider an approach that was not essentially a peer support intervention as opposed to an interesting approach that just happened to be implemented by peers?
GENERAL/OTHER (G)
G1. I would like to clarify if the funding can be for projects in the US and other countries, for example, The Netherlands, England, Australia, China, Taiwan, Turkey, and Egypt?
G2. Is it possible to apply for two implementation sites, one in each of two different countries? It would be great to be able to compare the impact of a peer support model in the two settings.
G3. Can a single grant fund project components in several countries? For example, could the PI be located in one country and a co-PI be located in a different country? Could the grant include project activities in several countries? In such cases, does one of the countries have to be the US?
G4. Will you be looking to fund programs geographically?
G5. Are the review criteria weighted, and if so, can we get the range of scores?
G6. Will more weight be given to interventions that include several regions/countries than the comprehensive interventions that serve a smaller community?
G7. If it’s a minority group, is there going to be any priority in rating or funding, or the flip side of that, if it’s not a minority group, is it going to have an effect on the funding?
G8. Is anybody considering working with ethnic minority groups?
G9. Will grant awards for interventions that target lower (SES) populations receive priority attention?
G10. Do you have a limit on the number of coordinated sites that you are looking for in the proposal?
G11. Where can I find the specific guidelines for writing up the proposal.
G12. Can a single individual participate in several applications?
G13. Can our organization submit a proposal and be a partner in a separate proposal?
G14. Should we need to include letters of support in our proposal?
G15. Are letters of support acceptable in the application?
G16. Can we include letters of support from community agencies and organizations?
G17. If letters of support are not needed, do you need a document such as a memo of understanding with our collaborating partners?
G18. Are letters of agreement from collaborators or sites needed?
G19. Do we need to have IRB human subjects approval at the time of application or can we obtain IRB approval from our institution prior to the intervention?
G20. Does an agency have to go through IRB process for the application process?”
G21. Are we required to have a data safety and monitoring board?
G22. Are there restrictions on what grant activities may occur during the first eight month period?
G23. Will there be pilot implementation during the planning phase?
G24. Will approval for phase one and phase two funding be approved at the same time? Do you need to submit or reapply after the eight-month planning phase?
G25. Please expand on the expectations for the eight-month feasibility period. The RFA implies a need to actually demonstrate feasibility and recruitment intervention evaluation.
G26. Is there any expectation that the applicants have an affiliation with the American Association of Diabetes Educators (AADE)?
G27. If we already have a defined curriculum, can it be presented as an appendix? Or does it need to be extensively defined in the body of the application?
G28. What material can be included in tables not counted toward the page limit?
G29. What about the organization’s board of trustees, lists, history, financials? Will these be needed to be attached to grants, and if so, are they part of the 20 pages?
G30. There’s no defined section for a description of key personnel and their skills set in the application. What section do you prefer this to be under, or does it simply get placed in the budget justification?
G31. Can you give firmer guidance on page limitations for the figures and tables that may be appended?
G32. If the graphs and tables are added to the end of the document, is it OK for the length of the document to be greater than 20 pages?
G33. The 20-page limit does not include figures and tables. Should we attach these after the main body of the proposal or integrate the tables within the grant?
G34. Are there two different types of grants, or is it just one type?
G35. How many preliminary projects were approved?
G36. Is the U.S. deadline August 31, is that midnight Eastern Daylight Time?
G37. How many sites do you intend to fund?
G38. Will the peer reviewers include a broad mix of individuals drawn from nursing, social science and evaluation scholarship, or should we anticipate a relatively narrow biomedical mindset?
G39. How much traveling will be involved in collaborating with the other grantees?
G40. Do you know if all grantees meetings, starting from January 2009, will be held in the USA?
G41. Can you explain the dissemination process or methods you will be using, publications?
G42. Will you provide reviewer comments to applicants?
APPLICANT CRITERIA (AC)
AC1. Can we submit an application with two Co-Principle Investigators (PIs)? My colleague and I would like to submit to this call together as we work in parallel with two different populations. We would like to propose an intervention using both populations.
It is fine to include two co-PIs. However, for administrative purposes, one will need to be designated as the PI responsible for coordinating and representing grant activities with the American Academy of Family Physicians Foundation and the Program Development Center. In cases in which proposed projects are to be carried out in several organizations or institutions, the Principal Investigator should be from the host or main organization that will be responsible for overall administration of project activities and funds.
AC2. Are Co-PIs allowed/acceptable?
Yes. Please see AC1.
AC3. Do potential grantees need to have a diabetes self-management intervention or program, intended to be delivered by peers, prior to applying for funding? Or will a program or intervention be developed for peers by the grantees and others during the development phase?
As indicated in the call for proposals, http://www.peersforprogress.org/proposals.html , the applicant needs to document experience in diabetes management and/or peer support interventions. There is no explicit requirement of an existing, self-management program although, if present, such would be pertinent to documentation of the diabetes management experience. There will be time during the development phase to finalize development of the proposed program. Please also see E1.
AC4. Your proposal has asked that we describe an "applicants' experience in development and evaluation research." I am a bit confused given that the proposal will be developed by staff members from three separate community based organization, one staff from an educational institution, and myself. How do I decide who is the lead person if we want this to be a team effort? If I include all of them, then my next concern would be the proposal length requirement.
We realize that this may be a challenge to team efforts and program development but, for administrative purposes, need to insist that one individual be the Principal Investigator for each project. This individual need not be the person on the team who is most experienced in evaluation research.
AC5. Could you please provide more detail about what you mean by “experience in research and program evaluation?”
We are looking to fund applicant groups that include among them individuals who have experience in carrying out research on health promotion and/or program evaluation in health promotion and diabetes, peer support interventions or similar types of programs. So it is very important that the evaluation grants include among their key collaborators people who really can make sure that each evaluation grant project is well evaluated and contributes toward the bulk of evidence supporting peer support intervention.
AC6. When you ask about experience with collaborative research, does working with different departments in the same institution qualify?
Yes, we are interested broadly in what your experience is with collaborative research. There is no particular formula for that. So however you want to do that or whatever makes sense given your experience and your background to articulate your experience with collaborative research will be fine.
AC7. Are Diabetes Prevention and Control Programs within state health departments in the US or other government based groups eligible for these grants? Are non-governmental organizations or community based organizations eligible to apply?
Yes, Diabetes Prevention and Control Programs within state health departments would be highly eligible and encouraged to apply. We are happy to receive applications by governmental organizations, non-government organizations, and community-based organizations. The critical eligibility requirements are experience and recognizable accomplishments in both (a) diabetes management and/or use of peer-based interventions in health promotion and chronic disease management; and (b) research or program evaluation are invited to apply.
AC8. Does the fiscal agent have to be an academic institution?
No. The applicants must include the kind of experience in evaluation described in the Call for Proposals http://www.peersforprogress.org/proposals.html , but it is not required that the fiscal agent for a grant be an academic institution.
BUDGET (B)
B1. In cases in which a grant includes components in several institutions and, perhaps, several countries, how should budgets be arranged? Should they be arranged as separate grants or as subcontracts within one "parent" grant? How is overhead handled in such cases?
There will be one grantee funded and that grantee will be responsible for any subcontracts that are arranged. In regard to overhead, the rate will be 18% and it will be paid on the total project amount. Any negotiations with subcontract overhead will be the responsibility of the grantee. NOTE: The 18% overhead is consistent with the content provided in the full call for proposals.
B2. Is there a specific format for the budget?
Here http://www.peersforprogress.org/proposal/application.html are the application forms. Beyond what is there, there is no specific format required.
B3. Do we need to budget for translation or is the material for the ethnic group to be targeted?
In terms of budget, depending on what curriculum you are proposing, budget accordingly. If you have identified a curriculum that you want to use, but it is going to need to be translated, then you should budget for that. The Program Development Center will be working actively with the grantees to encourage sharing of curriculum and program models and so hopefully we anticipate that the grantees will provide lots of suggestions and ideas and resources to each other so that everybody who is involved will be benefit by that kind of sharing.
B4. May we pay full-time peer mentors?
The spirit of Peers for Progress is that the mentors are volunteers, and we recognize that what a volunteer means, in actuality in different settings, may vary considerably so that in some settings volunteers may be paid – reimbursed for expenses or provided some honoraria for their services. It will be important that peer support programs be structured in this way so that they fit with what are the customs and practices in the population and the setting in which they are being implemented. In general, we do not see being a peer mentor as a full-time paid job, but if you want to make a case for why that is really an important approach to take, certainly that case could be made in an application.
B5. Is it acceptable to budget stipends for or pay full-time peer mentors?
Please see B4 above. Yes. You can justify expenses for volunteers, transportation expenses, training stipends, various kinds of honoraria as they relate to the context of your project. Reviewers will be attentive to what really is needed in the setting in which you are working to make the intervention make sense and to be acceptable to people. Keep in mind that we are looking to promote peer support around the world. It becomes readily apparent that how you do peer support in one part of the world may be very different than how you do peer support in other parts of the world. In your application, document how what you are proposing makes sense in your setting/circumstances, how it will be well accepted, and how it will result in a vigorous and widely supported program. That is the way to justify different procedures whether it is a reimbursement for volunteers or other particular approaches that you want to take.
B6. Can the people who are giving the support be a combination of volunteer and paid, or should they all be volunteers?
Please see B4 and B5 above. The spirit of Peers for Progress focuses on volunteer diabetes mentors and supporters. But we recognize that how you organize, recruit, support, and sustain volunteers may vary in different settings – and in a way, may sort of compromises a “pure volunteer” model. So whether you provide funding for travel expenses or modest honoraria or have a blend of volunteers and paid staff, whatever you do, you should justify it according to the program you are thinking is valued, relevant, and will be effective.
B7. Is there a limit to the kind and amount of financial support we can provide to our volunteers providing peer support? Can we provide a small amount of support as appreciation for their involvement? Can we reimburse them for time involved in their training? Can we reimburse them for their expenses?
Please see B6 above. It is intended that peer supporters be volunteers. However, it is also understood that, in different settings, it may be important to help volunteers with expenses that otherwise might prevent them from participating. Reimbursement for volunteers should be justified then on the basis of the particular volunteer group, the setting, and other practices in the region.
B8. Can grantees provide transportation?
Yes. Similar to what is outlined above (also see B7), justify these expenses in terms of what the practices are in your setting, the needs of the people you are dealing with, if necessary.
B9. In today’s environment of escalating costs, especially gasoline, can we provide vouchers for participants of diabetes to defrayed travel costs?
Please see B8. Yes, you can request funds to provide or defray travel or other costs for those involved in the program. Again, justify these expenses that in terms of the needs of the population and what is customary in your area. Again, you can propose reimbursement for expenses that you think are reasonable given the setting and the populations you are working with, and certainly gas money for peer mentors to meet with their peers would be appropriate.
B10. Our work with community health workers (CHWs) has included salaried, paraprofessional peer educators as CHWs. Is this model responsive to the call for proposals? Since there is much discussion and little evidence on the relative merits of the lay/volunteer and paid/staff models, PfP could be in a good position to shed some light on this important question if both types of models were included.
On the one hand, the spirit of the development of the Peers for Progress program has emphasized peers as volunteers. On the other, there is lack of clarity of pros/cons of paid/unpaid, certified/uncertified, etc. etc. There is also quite a bit of variety along these dimensions in peer support programs around the world. If you articulate this well and articulate the common features of peer support that cut across somewhat different formal roles, the reviewers may respond positively to your proposal. Although it is not possible to anticipate their decisions, they may agree with the value of PfP exploring somewhat different models along this dimension.
B11. If we feel that our peer support model proposes an innovative approach with potential broad impact, would it be better to propose a more modest budget for this grant or is it scalable – is scalability a priority at this point?
The overall goal of these evaluation grants is to show evidence that peer support, in its many different forms, as you might propose, is effective, that peer support matters. And if you think that a relatively modest program is really the appropriate thing for the ideas that you want to demonstrate, then propose a modest budget. Do not feel that you have to propose at least $500,000 to be credible. If you have something more modest that you think makes sense, feel free to propose it. The appropriateness of your budget for what it is you want to do will be one of the things the reviewers, will consider in making choices. So make sure that your budget really reflects your best knowledge of what it is you want to test and what it will really require to test it. Do not ask for a lot more money than you really need and do not ask for a lot less money than you really need. Either one would raise doubts in the reviewers as to your understanding of what it really will take to implement what you propose.
B12. Will grantees need to include travel costs to attend Peers for Progress meetings?
At this time, no. We will be working out how to budget that with the funded grantees. So we do not have exact plans for what the Peers for Progress meetings the people will need to attend are, so at this point, do not worry about including that in your budget. Those who are funded will be asked to add some money for travel costs subsequently.
B13. Is there support for meetings that the grantees will need to attend that should be included in the budget?
Please see B12. There may be face-to-face meetings for the grantees to attend. We will base this after we know where the grantees are situated and have a chance to really think seriously about the feasibility of organizing face-to-face meetings, or we may use web-based or other approaches to communication among the grantees.
B14. How much travel is anticipated for the first eight months for collaboration, or is travel indicated for dissemination of findings only? How much travel may be involved and to what locations?
Please see B13. After grant awards are made, we will be working with you to budget for grantee meetings and/or other communication.
B15. If sites are implementing an innovation and comparing it to conventional care as part of an existing service line, can the site still receive payment for the service even though the patient is joining a research study, i.e., physician care for diabetes care? Can we still expect and/or accept payment from insurance for conventional care and use the research funds to offset the innovative elements of the trial?
Generally the guideline is that funds from these evaluation grants will not pay for routine clinical care. They will be used to pay for the peer support interventions and the development and evaluation of the peer support interventions. So certainly, from our perspective, there is no reason grantees could not continue to receive payment from Medicare or other third-party payers for clinical services or covered services they are offering to participants.
B16. Can there be a component in the budget for training the peer mentors on the diabetes self-management plan and the diabetes national standards?
Certainly, you want to train the peer mentors on what you think is important for them to have familiarity with it and skill at, and so that depends on what you are going to be asking them to do as part of their peer support intervention. You can budget for training the peer mentors as part of your project.
B17. Is point of service A1C or (lipid tests) handheld machine is allowable in the budget?
Yes, if you need to purchase machines to carry out evaluations, that expense is certainly allowable.
B18. Can the program pay for resources such as glucose test strips in systems where patients have little access to them?
Unclear at this time. That would need to be carefully justified, and it might or might not be approved in final funding. For now, budgeting for this issue would not be a basis for either approving or not approving a proposal, but it might be a subject of budget negotiation if your project were selected for funding. If you think something is really important and you can make a case for it, go ahead and put it in your budget, and then we may negotiate some of those kinds of issues at the point where funding decisions are made. If you feel that a particular test/measure is justified, make the case for it, and then include it in your budget. If you are selected for funding, we will work out the details.
EVALUATION (E)
E1. In looking over the information regarding the calls for proposals for the evaluation grants, it is hard to tell whether grantees will evaluate existing programs or will create a program and evaluate it. Can you please clarify?
Grantees will be expected to develop and evaluate their own peer support intervention. In some cases, it may be worthwhile for a grant to focus on an existing peer support program. This is alright but it would be important to justify the reasons for wanting to evaluate this program and to document that it meets the broad characteristics of peer support for diabetes management outlined in the call for applications. Please also see AC3.
E2. The Call for Proposals indicates that funded projects “will use controlled research methodologies to study and document the contributions of peer support interventions for those with diabetes” (Call for Proposals, p. 2). Can you say more about what “controlled research methodologies” might be fundable?
It will be important that evaluation of peer support programs funded through Peers for Progress include controls for variables that may account for apparent benefits of peer support. Randomized designs are, of course, a sound approach to such control. However, because peer support programs are often embedded in and take strength from complex organizational, social or community contexts, randomized designs may not always be practical or most appropriate. Alternative designs may be proposed. These include but are not limited to such designs as:
In all cases, approaches to design and evaluation should be carefully justified with reference to the specific objectives of the project, the setting, and resources to support evaluation activities.
E3. What kind of controlled research design are you interested in?
See E2 above. It could be a randomized control design. It could also be a wait list or a delayed treatment kind of model. It could be a systematic program evaluation without an explicit control group. We intend to leave the applicants with quite a bit of leeway in how they want to design their evaluation. The emphasis will be on a thoughtfully worked out design that will allow you to generate data, to contribute to the overall bulk of finding that peer support is helpful.
E4. Is there a preferred study methodology, e.g., randomized control trial, cohort study?
Please see E2 and E3 above. There is no preferred study methodology. We talked about control approaches, but we recognize that there are a lot of ways of achieving control in research. We anticipate that people may want to do cohort studies, may do wait list or delayed treatment controls, may do multiple baseline approaches across different settings. People may propose careful educational evaluation methodologies that do not involve actual experimental control. A variety of approaches might be proposed.
E5. I read in yesterday’s material that you were not requiring the evaluation to be in the form of a randomized control trial. Is that still if your preferred method, if feasible?
Please see E4 above. As you know, this is an area in which wise people differ somewhat. Propose what you think is the most reasonable evaluation approach to the intervention that you are proposing and the setting in which you are proposing it. If a randomized control trial would work well in that setting and with that intervention, then that may be something you would want to use. On the other hand, if a randomized control trial would involve compromising the nature of the intervention or the promotion of it to a wide audience, then you might want to consider other design approaches. Overall, you need to justify the design approach on the basis of the intervention you are proposing and the setting and population in which you are proposing it.
E6. How would a randomized geographical cluster Controlled Trial of peer support fit into the joint international approach? Although we think we could do this with adequate power in our areas to test the efficacy of peer support with minimal contamination, would this fit into the evaluation approach you were thinking of?
Please see E5 above. The critical features will be the appropriateness of the evaluation to the program proposed and the likelihood of useful information regarding the benefits of peer support interventions and useful models for promoting them.
E7. We are considering a wait list design - is it necessary for this grant?
Please see E2-E6. A wait list design is certainly something that may be appropriate and would be within the range of designs that are acceptable.
E8. Can you give more advice on the controlled study design? Should it be a randomized control trial? Would a qualitative evaluation and analysis of intervention using focus group surveys and video analysis be welcome?
Please see E2-E7 above. It does not need to be a randomized control design. The design does need to enable identifying strong evidence that peer support is effective in improving diabetes management. A qualitative evaluation that was limited to focus group surveys or video analysis and did not include evaluation of outcomes, such as metabolic control, would probably not be competitive.
E9. Note on Evaluation of Program Reach
It has been estimated that 60% - 70% of patients with diabetes have not received self-management interventions (Austin Endocrinology Practice. 2006 12(Suppl 1):138-141). Peer support may contribute to alleviating this omission in diabetes care. To evaluate the success of peer support in reducing this problem, it is important that evaluation grants include characterization of the reach of their programs to intended audiences. This should include (a) specification of the population for whom the peer support program is intended, (b) some quantitative estimate of the size of that population, (c) estimate of the extent of reach through quantification of the extent to which that population is engaged in the peer support program, and (d) estimate of the extent to which those reached are representative of the population for whom the program is intended.
E10. How many participants should be included to make this a feasible study?
That really depends on the nature of what you are doing and your statistical analysis, etc. You obviously need to have enough participants to have a powerful statistical design that will give you an answer to these research question and the evaluation questions being raised. How many that is, is up to you, but that does need to be articulated in the methods. Please also see PS8 and PS9.
E11. Would we use common questionnaires/evaluation tools? If so, do we include a description of tools in any application?
After funded, grantees will work together and with the Program Development Center to identify some common evaluation measures. However, these will not preclude additional evaluation measures that are of interest to a particular grantee or especially pertinent to a particular project. Thus, applications should propose a complete plan for evaluation of their own proposed intervention.
E12. To what extent will measures and instruments be agreed upon and shared between projects?
What we anticipate is that some key evaluation or outcome measures will be shared. We do not have a specific list, but we anticipate that these may include a measure of metabolic control, probably glycated hemoglobin, some measure of the individual's behaviors to manage their own diabetes, and some measure of quality of life. Currently, this has not been finalized. Our plan is to keep the shared outcome variables, keep that to a short list, so as not to be too much of a burden to the individual projects. We want each of the grantees to feel that they are also going to be able to use outcome measures that they like, that they may have a particular interest in, and we do not want to overload them with shared measures. In the standardized evaluation indicators used across all of the grantees, we want to strike a balance between the ability of the grantee to plan and to implement their own evaluation according to their interests and achieving some standardized evaluation across grantees. So our anticipation is that the number of standard measures used by all grantees will be kept short in order to facilitate the grantees doing their own individual approaches to evaluation.
E13. Since funded grants will be asked to use common evaluation instruments and measures, should proposals include outcome measures and process measures?
In a word, “Yes.” The development of shared outcome measures will be collaborative among the groups funded for these Evaluation Grants. Therefore, applications should include proposed process and outcome measures. From these as well as measures identified by the Program Development Center, the final set of shared outcome measures will be identified by the grantees and Program Development Center staff. However, the set of shared measures will be kept modest so that individual grantees may also include measures of their own choosing without excessive respondent burden.
E14. Is there an expectation that we should collect blood work from peers as part of the evaluation?
We anticipate that the evaluation of projects will include measures of metabolic control that will entail some kind of blood collection. If you want to measure additional clinical measures beyond measures of metabolic control, then that should be justified in your proposal.
E15. Is the interest primarily on glycemic control or is blood pressure and lipid control also considered part of metabolic control?
Please also see E11-14. We may end up focusing on glycemic control as a shared outcome measure, but that has not been decided. The sites who end up getting awarded grants will participate in that decision. Certainly individual applicants may want to include measures such as blood pressure or lipid control as also important measures of what they are trying to influence.
E16. Is anybody considering using a psychosocial outcome measure?
Please also see E11-15. We anticipate that this is not carved in stone. We will finalize this collaboratively with the grantees who are funded. Inclusion of more detailed psychosocial measures beyond general quality of life measure is pending.
E17. How much emphasis is being placed on changes in the peer supporters, either physiological or psycho social versus the actual participants?
The question “To what extent may peer support be reciprocal?” is an interesting and important issue for peers support. And depending on the different program and interventions proposed, the extent to which those boundaries are blurred may vary considerably. If you choose to propose monitoring the effects of being a peer supporter on the peer supporters themselves, please include that in your application (although it is not required).
E18. Is it expected that we should build in time following the intervention period to complete the evaluation and analysis?
Yes. The 24 months of implementation after the initial eight-month period should include final evaluation and analysis. So you are probably not going to want to propose a pre-post design with 24 months in between because you would not have time to analyze the data that you gather.
E19. Will our final evaluation report be due during the funding period? Or within a specified time period after the funding period?
Also see E18. We have not worked out the specific requirements of that. We anticipate that after your funding period is over, in a number of cases, people would continue to be writing reports and publishing papers on their work.
E20. What do you consider long-term follow-up? One year, two years, multiple years, a lifetime?
Also see E18 and E19. There are different ways of looking at this. It might be to recruit people at different points in their career with diabetes so that one might evaluate peer support for people who are within a couple of years of diagnosis and also include people who are a number of years out from diagnosis. So there might be different ways of addressing it. Obviously with the 32-month funding period, we are expecting follow-ups of, at the most probably, 24 months. Please also see PS26 – PS 28.
E21. Is there a minimum period of follow-up that is a requirement?
No. I think you propose what makes sense for what you aim to look at.
INTENDED AUDIENCE/SETTING (IA)
IA1. Is the Peers for Progress Evaluation Grant allowed to address non Medicare beneficiary adults?
Yes.
IA2. Is Peers for Progress only geared toward diabetes or does it include other illness groups?
As indicated in answers to other questions (please also see PS10), the overall purpose of Peers for Progress and of these Evaluation Grants is to promote peer support for diabetes. Thus, grants funded through this mechanism will need to include those with diabetes and to evaluate intervention approaches that are broadly pertinent to diabetes. However, interventions need not be limited to those with diabetes. For example, in some cases, a case might be made for inclusion of individuals who do not have diabetes on the basis of enhancing the support for or sustainability of an intervention.
IA3. Are proposals addressing children and youth appropriate for Evaluation Grants?
Because the needs and circumstances of children with diabetes are so different than those of adolescents and adults, procedures and practices for promoting peer support for children would need to be substantially different than those for organizing and providing peer support for adolescents and adults. Thus, initially, PfP will not be focusing on peer support for children with diabetes. Since Evaluation Grants are intended to guide broader efforts to promote peer support, it makes sense also to focus these grants on adults and adolescents. Accordingly, in this round of funding of Evaluations Grants, applications focusing on children will generally not be competitive. Applications focusing on adolescents and adults should be developed with consideration of the generality of their procedures and findings to others with diabetes. Subsequent phases of PfP may extend to include peer support for children with diabetes. This surely would be a worthy area of activity. However, in order to enhance the impact of current funding, the focus of PfP and the research it supports at this time will be on peer support among adolescents and adults for whom similar procedures and approaches to Program Development are possible.
IA4. We work with youth – empowering youth to act as agents for change in South America with the diabetes community, but our work has been mainly concentrated on type I diabetes. Do you think this would be acceptable as part of this study?
Please also see IA3. We are looking for projects that will test approaches that can be used with adults with diabetes, and to the extent that they are focused on children, it is probably going to be hard to take a program for children and extend it to adults with diabetes. On the other hand, one could imagine some programs for adolescents that could be readily extended to adults. So you need to make that judgment. But please keep in mind that your proposal will be evaluated against the criterion of the extent to which it shows the value of peer support interventions that can be used with large populations of adults with diabetes.
IA5. What about special needs or populations among those with diabetes, such preconception counseling or those with specific problems associated with diabetes such as blindness, amputations, or depression?
The objective of Peers for Progress is to promote peer support for the general population of those with diabetes. Interventions tailored to the needs of just a particular group may tend to focus on intervention components not especially pertinent to the needs of the broader population of those with diabetes. As such, they would not be especially appropriate for these grants. On the other hand, it is important to recognize the prevalence of other problems – depression and other mental health issues, aging, etc. – with diabetes. So the “norm” for diabetes is for diabetes to be accompanied by other problems. Thus, interventions that (a) are broadly appropriate to the needs of those with diabetes and (b) pay particular attention to common problems such as depression or vision problems would be appropriate.
IA6. Because a significant portion of the mentally ill population is affected by diabetes, especially due to the effect of psychotropic medications, would they be viewed as an eligible population or be considered special needs and therefore ineligible? Our intention would be to draw upon the documented success of the mental health recovery movement in delivering consumer-driven peer supports and services in the United States and explore our share of best practices that can be applied to the population at large.
The last sentence there is the key. The reviewers will be looking to see that the grants supported are evaluating peer support interventions that are broadly applicable. If what you propose could only be implemented with mentally ill populations, then it would probably not be of great interest. However, if it were implemented with mentally ill populations, but in a way that would provide a model for broader populations as well, then it might be of great interest.
IA7. Is addressing a population with pre-diabetes or focusing on diabetes prevention within the scope of this grant?
Again, this goes back to the kinds of issues talked about related to focusing on mentally ill populations (please see IA6). We are looking to document the value of peer support for diabetes management in general. That certainly can include prevention among folks with pre-diabetes, but if an intervention were focused on prevention in a manner that made it less applicable to diabetes management, it probably would not be viewed by the reviewers as being very competitive. Also, keep in mind that the purpose of these evaluation grants is to show evidence of the value of peer support in managing diabetes. So you can include people with pre-diabetes, but you should not be focusing exclusively on people with pre-diabetes. Your intervention needs to have a substantial focus on people with diabetes.
IA8. I asked a question about pre-diabetes, and I just wanted a clarification on the answer. So if we were to target a population at risk for diabetes with diabetes prevention activities around behavior change and it did not specifically deal with diabetes management, then that would not be what you are looking for, is that correct?
I would not want to prejudge, but I would argue that if you proposed that, you would want to justify why you think it would contribute to our understanding of peer support interventions for people with diabetes. The critical thing is that your project gathers data that helps us understand and promote peer support interventions for people with diabetes.
IA9. We worked with not only people with diabetes, but their families, and we also worked with older patients who may be mentally compromised. How much of (this) can we do as far as people who do not have diabetes but who are at risk or are caregivers of people who have diabetes? Can we include them, and if so, how?
There are no real clear-cut answers to these questions. It needs to be judged individually. We certainly recognize that if you are dealing with somebody with diabetes and their family is not on board, that is a problem for the person with diabetes. Including family members may be very pertinent, and in a particular setting, it may be more effective in terms of reaching and recruiting participants and disseminating a peer support intervention and make it open to people with a variety of problems and not just diabetes. In that case, what you might want to do is focus your evaluation on people with diabetes while you open your program to people with a variety of different problems.
IA10. Do you have a view on when a program should address both Type I and Type II diabetes, or can we focus on Type II because we envision that group support will work better if we are including people with the same type of diabetes?
Again, this goes back to the issue of generality of findings (please see related IA5-IA7). We are looking to promote peer support for the bulk of people with diabetes, and that obviously is people with Type II diabetes. You could certainly include people with Type I diabetes. If you feel that it is justified; if you want to focus just on those with Type II, you can do that also. Depending on the setting in which you are working, it may be hard in real world settings to discriminate between Type I and Type II diabetes, so you can propose what you think is best in that area.
IA11. Would Peers for Progress prefer proposals to focus on clinical settings as opposed to non-clinical settings such as educational settings?
We are happy to have applications from clinical settings. We are also happy to have applications from non-clinical settings. It would be important, regardless of the setting, for the peers to be addressing and encouraging active linkage with and engagement in clinical care. But there are no specific requirements that the intervention be either clinical or non-clinical.
IA12. What importance will the grant review process attach to how the framework and design of the project will be applicable to other sites, regions and countries?
A proposed support intervention that only can be implemented in a particular site or in a particular kind of setting that does not have broad applicability would be of less interest than one that has broad applicability. You and your application do not need to document how it could be implemented in varied settings. Describe the intervention and the kinds of resources that it will require in a way that makes it clear that these are not unusual or terribly unique resources. Such descriptions should be enough for the reviewers to feel comfortable.
PEER SUPPORT INTERVENTION (PS)
PS1. We are wondering if, for the purposes of this RFP, we might be able to cast medical students as peers providing support for patients with diabetes--or even, could we cast patients with diabetes as peers with medical students.
As with a number of other questions (please see related IA5-IA7), the issue here is the generality of the findings your project would produce. The objective for these Evaluation Grants is that they provide information, evidence, and program models that will guide the overall promotion of peer support internationally. Were your project to be structured so that its findings and curricula pertained only to medical students, it would not be as strong as if its findings and models had more general applicability.
PS2. How exact is the definition of peers?
Peers are people with diabetes or people who have a connection with those with diabetes, such as family members and friends. We have intended to define peers quite broadly and so we really do not have an exact definition of peers. The related issue here is that we are looking for peers to be volunteers. We recognize that in different settings, volunteers maybe need to be paid various types of ways to offset costs of being a peer (please see B4-B7). But we do not have any hard and fast definitions there.
PS3. Would you consider diabetes educators and/or CDEs (certified diabetes educators) to be peer mentors?
We are probably, in general, thinking of peer mentors as nonprofessionals rather than professional diabetes educators or CDEs. But in a particular setting, one might make a case for people with that background functioning as peer mentors. One would have to make the case carefully.
PS4. Can peer mentors be employees of a community-based organization or must they be volunteers?
Please see PS 2 and PS 3. The spirit of Peers for Progress is that they be volunteers. We recognize that defining volunteers may vary depending in different contexts and different settings. One would need to make a case for why what you are proposing would be generalizable to a variety of peer supporters. This is really an issue of generality of finding. If what you are proposing is an intervention, a peer support intervention, that is very limited to a particular kind of setting or a particular kind of procedure, then it would be less competitive than if it were generalizable. However, if you are going to study the community employees at a community-based organization, but you are going to study them in a way that what you learn, what you analyze would be broadly applicable to different groups of peer supporters, then that would be a lot more competitive than if it were only applicable to employees of a community-based organization.
For questions about paying peer mentors, please also see B4-B7.
PS5. This question is driven more by curiosity versus information seeking. Besides wanting to inform the development of programs with greater potential of sustainability, compared with most lay health assistant interventions, what prompted the committee to want to test the volunteer model?
The spirit behind the volunteer model is a sense of trying to move peer support into the naturally occurring circumstances of lives of individuals with diabetes. In many respects, there is a continuum between volunteer versus lay health advisor and other models. One could write applications that articulate that continuum and make the case for what one wants to propose. Keep in mind that the overall spirit here is clearly one of people with diabetes helping other people with diabetes, volunteers helping others, non-professionals helping others. These concepts are to some extent overlapping, so the applicant needs to propose a particular approach in a particular setting with a particular population that is relevant and makes the most sense.
PS6. Is the expectation that peers will themselves have diabetes? Or can they be members of the target communities?
Please also see PS2. The language that we have put in the call for proposals is that peers need to either have diabetes or have a close connection with diabetes, such as a relative or a close friend. Please refer to http://www.peersforprogress.org/proposals.html . The expectation is that many peers will themselves have diabetes, but that is not an absolute requirement.
PS7. We have considered an intervention using a mix of medical assistants from the office as well as patients. Is it a requirement that mentors have diagnosis of diabetes?
Please see PS1, PS2 and PS6. It is not a requirement that mentors have a diagnosis. Mentors need to be people with diabetes or with a close connection to those with diabetes, and medical assistants would probably qualify by that criterion.
PS8. Do you have any expectation of a certain number of participants to be involved as mentees or mentors?
We do not have specific numbers involved. One can imagine situations in which a single peer might be providing services to a number of people with diabetes. In other cases, it might be more of a one-to-one, one peer for one non-peer or one mentor for one mentee. There is not a fixed formula. As part of your evaluation plan, you should be able to document that you will be recruiting and evaluating enough participants so that you will be able to make reasonable conclusions as to the value of the peer support interventions. Please see E9 and E10.
PS9. Are there guidelines for the ratio of lead peers to peers?
Please also see PS8. No, we do not have any a priori or specific guidelines for that. We could imagine in some cases a peer mentor may have a case load, if you will, of a dozen people with diabetes. In other cases, the peer mentoring may be organized through a network in which an individual is linked with a single mentor/mentee, and that would be what makes up the network. We are looking forward to inventive proposals regarding different ways of structuring peer support. Please also see E9 and E10.
PS10. Does the definition of a peer support program include group based peer support in a clinic setting? Does it include the peer support in shared group medical appointment visits?
In general, support groups and group medical visits might be useful components of a peer support program. However, a program focused solely on either of these two approaches in a manner that is not generalizable to other, broader approaches, would probably not be highly competitive in the review process. Please keep in mind that the overall objective of Peers for Progress and of these Evaluation Grants is broad promotion of peer support for diabetes. Thus, grants will need to justify the applicability of the interventions they propose to populations with diabetes. Interventions of limited generality are consequently of limited interest. Please also see the answers to other questions (e.g., IA2, IA5).
PS11. What about support groups?
Please see PS2 and PS10. In different settings, it is likely that peer support will be provided through both group and individual interventions. It will be important that research supported by PfP address both of these modes as well as other modes of support such as by telephone, electronic media, or worldwide web. Applications emphasizing group approaches should be developed with attention to the generality of their procedures and findings. Applications focused on unique or distinctive group-based approaches that could not be implemented through individual support or other modes of support would be less pertinent to broad efforts to promote peer support and, thus, would need to be especially well justified.
PS12. May I propose a common [intervention] protocol to follow for all those who may be interested to the studies on the subject? Maybe the different sites may just introduce variations based on what can be done in their areas?
It is anticipated that applicants for these grants will have a commitment to their own approaches to peer support. Thus we do not anticipate encouraging all grantees to choose the same intervention procedures. However, as indicated in the Call for Proposals, there are some key or common characteristics of peer support for diabetes management that each application should address. Please see PS13.
PS13. Is it the case that applicants will submit proposed peer support interventions, but that the actual intervention will be developed by the group of chosen investigators so that all sites will do the same intervention?
No. We recognize that peer support may be organized in many different ways in different settings. This is especially pertinent to the goal of Peers for Progress to promote peer support around the world. Thus, those awarded grants will be encouraged to implement their own approaches to organizing and implementing peer support. In addition, please keep in mind: although proposed interventions should be of the applicants’ own design and reflect the settings and populations with which they work, interventions should reflect the three “key components that capture the essence of peer support” described in the Call for Proposals, http://www.peersforprogress.com/proposals.html
It is expected that these three broad components or features of peer support still leave substantial latitude for design of specific interventions that reflect the thinking of applicants. With this emphasis on grantees proposing and testing their own approaches to peer support, there will at the same time be a process of collaborative program improvement among grantees during the first 8 months of funding. This will not be to achieve a single protocol implemented by all, but to provide opportunity for sharing of good ideas and approaches to maximize the quality and interest level of each. Finally, as outlined in E11-E13, there will be a shared set of outcome measures developed during the first 8 months of funding, but not a shared intervention protocol.
PS14. To what extent do you anticipate applicants will work together if funded and adapt the way that we develop and deliver the peer support interventions after decisions on funding? To what extent will approaches be developed in common, and to what extent will we be developing our approach as separate projects?
You will maintain ownership of your own project and your own approach. We will encourage you to share ideas with each other and to work together and hopefully improve each of your projects. But what you implement will be up to you. You will not be forced to implement a common protocol developed by the team of grantees. Please also see B3, PS13, PS21, and E11-E13.
PS15. Please comment on the strength of an application regarding rigorous statistical control versus creative and/or tailored interventions.
Reviewers will be looking for both solid evaluation approaches and creative interventions, and will be looking to fund applications that blend those. We anticipate that peer support will need to be highly individualized and flexible in response to the needs of the individuals receiving that support. So we anticipate evaluating not so much specific content of peer support as the general approach to peer support that is being proposed in each grant. Again, going back to the three key functions of (i) assistance in living with diabetes day-to-day, (ii) emotional and social support and (iii) linkage to clinical care (please see PS13), we recognize that implementation of these components will vary very much from site to site and even from individual to individual within sites. We anticipate that evaluation will examine the overall contribution and value of those three key functions. Please see related Evaluation FAQs.
PS16. There is already a curriculum for diabetes education of the International Diabetes Federation (IDF). Will this be used as a template for the train-the-trainer or expert people with diabetes to provide peer support? Or will an independent curriculum be developed by the group?
You are free to draw on curricula such as those from the IDF if you choose. You are also free to propose your own curriculum, your own program model for peer support. Remember again that you need to address those three key components of peer support, (i) assistance in living with diabetes day-to-day, (ii) emotional and social support and (iii) linkage to clinical care. Please see PS 13.
PS17. For institutions where patients are all linked to the healthcare system, how do we specifically address linkage to clinical care?
Linkage to clinical care involves access and also engagement with and use of regular, ongoing clinical care. Patients may be in a healthcare system where they have access to clinical care, but that does not necessarily mean they are actively linked to and using it. Peer support helps individuals take advantage of and use the clinical care they have.
PS18. Can you talk a bit about the level of responsibility you have in mind for grantees with regard to linkage to clinical care?
That would depend on the setting and where peer support is being implemented. What we mean by that is that peer support should work with the individuals to help them link to and be engaged in clinical care. It may involve peer supporters having some kind of a communication link to sources of care themselves so that they can bridge the communication between participants and their sources of clinical care. That would depend on the setting. An important issue in diabetes management is that many people are not getting the clinical care to which they have some level of access, and so peer support should address people’s getting the clinical care they need. Please also see PS17.
PS19. What do you mean by intervention?
By intervention we mean the peer support provided - what it is that the peers are doing for the people with diabetes with whom they are working. Again, go back to the three key components of peer support as the three key components of the interventions to be tested here. Please see PS13.
PS20. Is the model of peer support for diabetics inspired by and similar to the models of narcotics anonymous), etc?
Yes – you can you draw on models from different areas of peer support, peer-based and community-based interventions. One of the criteria for eligibility is either experience in diabetes management or experience with peer support interventions even if not with diabetes management. So, yes, we would be happy to see thoughtful ways in which interventions, peer support interventions, from other areas might be applied to diabetes.
PS21. Do we have to have the curriculum completely written at the time of submission? Or can the first eight months be used for this?
In your application, describe in some detail the curriculum that you would be planning to use or the program model or the program approach that you will be planning to use. Then, part of the goal of the first eight months is to flesh that out. Reviewers will want to have a sense that you have a clear idea of what you want to do, but we also understand that your ideas will evolve over those first eight months and especially through exchange with other grantees and also through the Program Development Center. We will be providing information to all the grantees regarding various curricula that are available and that are pertinent to peer support in diabetes, and so we expect that all of the grantees' programs will evolve somewhat over that first eight months of funding. See related PS22, AC3, E1, G23, and G24.
PS22. Can wconsider the first eight months of the grant as a pilot testing phase in which we later can define and refine the intervention and evaluation – before implementation for the next two years?
Yes. But keep in mind that you need to propose a clear peer support intervention that you are planning to test. So your proposal should not say that your intervention is under development over the next eight months. You need to have an idea of specifically what you are planning to test and to implement, and describe that in your application. If you are funded, then certainly you can work on refining that during the eight months. See related PS 21, AC3, E1, G23, and G24.
PS23. Can you use an already-established evidence-based best practices and intervention, or are you required to develop a new intervention?
You can use already-established best practices and interventions. We would anticipate that over the course of the eight-month, first phase offunding, how you implement, how you train people to implement, how you recruit for, how you promote your intervention may evolve in some respects. But you certainly can propose a best practice as the core of the peer support intervention you propose. Please also see PS21, PS22, AC3 and E1.
PS24. Given that the underlying purpose of this grant is to build evidence for peer support, is it OK to propose a novel innovative first-time approach? While we would rely on our experience, we would like to target a new audience in a specific setting that has its own infrastructure for sustainability.
All of that sounds fine. The reviewers will be intrigued by interesting and innovative ideas, but they will also be concerned for approaches that could be implemented in a variety of different settings. Therefore, approaches that are dependent on a unique resource or feature of a setting will probably be less positively viewed than others. Please also see PS23.
PS25. In reviewing the call for proposals, there were several links to the (WHO) report and well-tested interventions. For the purpose of this evaluation grant, can I use those methods but demonstrate how effective it would be with my populations (Southern minorities and financial challenges)?
Yes, that would certainly be a reasonable approach to take. It is perfectly appropriate to draw on previously tested and previously documented interventions and then organize them so as to provide peer support in the setting and with the population on which you want to focus. Please also see PS24.
PS26. In recent communication, you mentioned the importance of long-term support, yet we have found that getting volunteers involved requires specifying a given time frame for their involvement. If we specify a given time frame for their involvement, are we shooting ourselves in the foot?
There are inherent challenges here. A 50 year old person with diabetes is liable to have diabetes for 20 or 30 or 40 more years, and no one is going to volunteer for that long. So one needs to think about how peer support interventions or programs could be organized to provide ongoing peer support over an extended period of time, but not necessarily provided by a single individual.
In a recent communication, we outlined how we are not seeing peer support as peers implementing a time limited program of, say, six to eight sessions or meetings: http://www.peersforprogress.org/proposal/announcements.html. We are looking for interventions or peer support or supportive interventions that extend more into the ongoing, living life with diabetes that really is so important. A major predictor of sustained impacts of self management programs is the duration of intervention. So it becomes increasingly clear that providing or planning for ongoing support for chronic diseases like diabetes is important
PS27. I have a question about a comment that was made earlier about the expectation that there's a very long-term involvement of the programs that we're defining for our grants. The understanding that I got was that the expectation is that it's not just a short or delimited term intervention or program, but in fact, it's something that goes across a considerable life course of the individual.
Please also see PS26. People live decades with diabetes, but we do not have too many intervention studies that go on for decades. And so there are challenges to research methods and programmatic challenges. We see peer support as largely for helping people live with diabetes over an extended period of time. The intervention needs to address the need for ongoing peer support for managing this chronic disease.
PS28. Can you clarify the recommendation we receive to propose ongoing long-term support for the proposed peer support interventions? Many programs have specific time-defined intensive educational interventions, especially during initial diagnosis of a hospital discharge.
Please also see P26 and P27. Yes, we understand that, and certainly your peer support intervention may include a time-limited or intensive education intervention or may build on that, but we are looking for peer support that supports ongoing diabetes management, not just the initial education of people regarding self-management skills and the like. So we really want peer support interventions here to address the needs of those with diabetes for ongoing support, encouragement, assistance in managing their diabetes day in and day out for decades at a time.
PS29. Given the period of the grant, eight months planning phase, 24 months implementation phase, is there a preferred length of participation for subjects?
We really plan on leaving that to the grantees to propose what makes the most sense given the nature of the intervention in the population you are working with. Obviously, the 24-month implementation phase needs to include some time for evaluation at the end of people’s participation and analysis of data and write up of results. So the intervention would most likely be somewhat less than 24 months, and it may be considerably less. Also please see PS26-PS28 and E18-E21.
PS30. Follow-up question about the breadth and focus of the nature of the peer support.
Applicants should think carefully about whether they are proposing a robust approach to peer support or, of less interest to this grant program, a relatively unique intervention approach that will merely be implemented by peers.
PS31. Can you give some examples of what you would consider an approach that was not essentially a peer support intervention as opposed to an interesting approach that just happened to be implemented by peers?
Example: Writing a diary as a way of improving adjustment and emotional well being is an interesting intervention that is being used widely in a lot of settings now. You may propose a program on peers encouraging each other to write diaries. That is really a test of peer implementation of diary writing. It is not a test of a general, robust approach to peer support. A more concrete example may be with blood glucose monitoring. Using peers to teach others to do blood glucose monitoring would not be a test of peers providing broad and/or ongoing support for diabetes management and living with diabetes in general. So in other words, we are not looking for you to take an intervention that works, add a peer component, and examine if it works when implemented by peers. The focus of these Evaluation Grants is peer support and its three components: assistance and coaching in daily living with diabetes and daily management of diabetes, social and emotional support, and linkage to clinical care. Please also see PS13.
GENERAL/OTHER (G)
G1. I would like to clarify if the funding can be for projects in the US and other countries, for example, The Netherlands, England, Australia, China, Taiwan, Turkey, and Egypt?
Yes it is perfectly acceptable for the projects to be outside the US and to combine sites from several countries.
G2. Is it possible to apply for two implementation sites, one in each of two different countries? It would be great to be able to compare the impact of a peer support model in the two settings.
Yes, this would be within the realm of things that might be very worthy of funding. Please also see AC1.
G3. Can a single grant fund project components in several countries? For example, could the PI be located in one country and a co-PI be located in a different country? Could the grant include project activities in several countries? In such cases, does one of the countries have to be the US?
We are looking to fund projects around the world. They do not need to be limited to one country. The US does not need to be included. Please see G1 and G2.
G4. Will you be looking to fund programs geographically?
We are anticipating funding programs both in and outside the United States, and we would be pleased if there is some geographic balance in terms of the programs from different parts of the world. But we will strike a balance between that geographic diversity and the quality and the pertinence of the applications we receive. So geographic diversity will be a consideration, but it will not be an overriding consideration.
G5. Are the review criteria weighted, and if so, can we get the range of scores?
We do not have weighted review criteria, at this point. We will be relying on the general judgment of the reviewers regarding the most meritorious grants and those that will contribute to the bulk of data supporting peer support.
G6. Will more weight be given to interventions that include several regions/countries than the comprehensive interventions that serve a smaller community?
No. Reviewers will examine a comprehensive and relevant intervention (as guided by PS13) and a thoughtful and a comprehensive evaluation model. The number of countries involved would not be a major determinant of the reviewers.
G7. If it’s a minority group, is there going to be any priority in rating or funding, or the flip side of that, if it’s not a minority group, is it going to have an effect on the funding?
We certainly anticipate that some of the grants, perhaps most of them, will be focusing on groups that are especially burdened by diabetes. That could include minorities, it could include older adults, et cetera. We are happy to receive grants focusing on minority groups or underserved groups or groups living with disadvantage. But that is not a requirement.
G8. Is anybody considering working with ethnic minority groups?
Many brief proposals due July 1 indicated a focus on ethnic minority groups.
G9. Will grant awards for interventions that target lower (SES) populations receive priority attention?
I do not know that they will receive priority attention. Reviewers, as well as the leadership of Peers for Progress, are very aware of the striking disparities in diabetes, not only within the United States, but around the world, and see peer support as a way of addressing that disparity. Bu it is not necessary that every grant target individuals that are burdened with disparities in diabetes and diabetes care.
G10. Do you have a limit on the number of coordinated sites that you are looking for in the proposal?
No. We are happy to have proposals that include a number of coordinated sites. There is no limit on that. There is not necessarily an advantage to having more sites than fewer, but there is also no limit on the number of sites. Please also see AC1.
G11. Where can I find the specific guidelines for writing up the proposal.
These were distributed after the July 1 deadline for brief descriptions. Please see http://www.peersforprogress.org/proposal/application.html for specific details regarding Full Proposal Guidelines due September 1, 2008.
G12. Can a single individual participate in several applications?
Some individuals may have the opportunity to participate as consultants, key staff, or co-Principal Investigators in several applications. There is no restriction on this for these Evaluation Grants. However, applicants should be aware that if several grants have very similar focuses or interventions, it is unlikely that more than one would be funded. Serving as Principal Investigator on more than one proposal is discouraged and no Principal Investigator would be funded for more than one proposal.
G13. Can our organization submit a proposal and be a partner in a separate proposal?
The answer is yes. You would want to be clear that the two roles were not competitive (if they were competitive, then it would be hard to see how both would be fundable). Being clear about what the roles are would be helpful there. Also see G13 above.
G14. Should we need to include letters of support in our proposal?
No, that will not be necessary. Please document in the text of your proposal the nature of your relationship with the collaborators and the nature of their contribution to the project and the basis for your confidence that that collaboration will be successful. We would prefer that you not include in your application letters of support unless they are attesting to some particular type of support or resource that is central to your proposal.
G15. Are letters of support acceptable in the application?
Please see G14. If you were selected for funding, the final funding decision will include documentation that all persons/organizations presented are ready to collaborate.
G16. Can we include letters of support from community agencies and organizations?
Please see G14 and GS15. Please do not include routine letters of support from community agencies. We are going to have a major task on our hands in terms of coordinating the volume of applications we expect with reviewers on a very tight timeline, and so we would appreciate if you could confine the application itself to what has been requested in the documentation we have circulated.
G17. If letters of support are not needed, do you need a document such as a memo of understanding with our collaborating partners?
We do not need a separate document in the application. We may require that if you are chosen to be funded with more formal documents later on. But because the initial application is due September first, we do not need a memo of understanding, but in your text of your proposal, you could just describe how the various collaborating partners have come together and how you have assured that they are all aware of what is being proposed and in agreement with it.
G18. Are letters of agreement from collaborators or sites needed?
Please see G14 – GS17. We do not need letters of agreement from collaborators. If one of your collaborators is going to be called on to provide some especially effortful or unusual contribution to the program that would raise questions in the reviewers’ minds about whether they really can do that, some documentation of their ability and willingness to do that would be in order. But we do not – we would prefer that you not include letters of agreement with collaborators where their agreement is obvious from the substance of the proposal. In your proposal, you probably want to describe who the collaborators are and what they each bring to the table and what the nature is of their agreement to collaborate.
G19. Do we need to have IRB human subjects approval at the time of application or can we obtain IRB approval from our institution prior to the intervention?
Applicants should write what your IRB approval is and in general address the human subjects issues that your proposed activities would entail. But we do not need to have formal IRB approval prior to the identification of you as going to be awarded an application.
G20. Does an agency have to go through IRB process for the application process?”
Please see G19 above. We would like you in your application to describe your IRB approach and describe the basic approach you will take to assuring protection of human subjects in the research project. But we recognize that different countries and different settings have different IRB requirements. So when we have identified those who are to be funded, we will work with them to make sure IRB approaches are completed appropriately prior to proceeding with active involvement in their program.
G21. Are we required to have a data safety and monitoring board?
At this point, no. We are going to be developing IRB and human subjects regulations after we have completed initial phases of the review and then identify those to be funded. Because we anticipate funding grantees from around the world, we are going to have to deal with the fact that in different countries there are different standards for protection of human subjects.
G22. Are there restrictions on what grant activities may occur during the first eight month period?
Not really. We anticipate that some or most or perhaps all grants will include some formative evaluation, perhaps focus groups and the like, to fine-tune their programs. People may pilot their interventions with small groups to just make sure that things are able to be implemented the way they expect and so that will be fairly open during the first eight months. Please also see PS 21 and PS22.
G23. Will there be pilot implementation during the planning phase?
Yes, we anticipate that that will be a common activity during the planning phase. I do not think it will be required. It is almost hard to anticipate how someone would not do some kind of pilot implementation during the planning phase. But as I say, that is certainly not a requirement. Additionally, individual applicants may be proposing formative evaluation, focus groups, developing approaches to training peers, et cetera, during that eight-month planning phase. Please also see G22, PS 21 and PS22.
G24. Will approval for phase one and phase two funding be approved at the same time? Do you need to submit or reapply after the eight-month planning phase?
We do not anticipate any formal or extensive reapplication. We may have a contingency that, on the basis of a progress report, satisfactory progress is made through the first eight months of funding prior to the release of the funding for the subsequent 24 months.
G25. Please expand on the expectations for the eight-month feasibility period. The RFA implies a need to actually demonstrate feasibility and recruitment intervention evaluation.
We will want to be comfortable at the end of that eight months that each of the projects is feasible and able to achieve recruitment and intervention evaluation goals. That will be part of the appraisal made in the initial review of grants, and it will be a continuing point of appraisal through the eight months of that initial funding period. We are not going to fund anybody who we do not have full expectations will be successful, but if it turns out in a particular case that a project through that eight months is just not going to be successful, we may work with the grantee to figure out an appropriate way of dealing with that, whether it is to change the project or to agree not to continue funding it. Overall, we have absolutely full expectation that the grantees that are awarded will be well poised to be successful with their interventions and their evaluations.
G26. Is there any expectation that the applicants have an affiliation with the American Association of Diabetes Educators (AADE)?
No, there is no specific expectation of an affiliation with AADE. The AADE is a partner along with the American Academy of Family Physicians Foundation in Peers for Progress and is very interested in working with the grantees and working with the overall program. So there will be opportunities through the course of implementing the grants to probably have some interaction with AADE, but there is not specific expectation or requirement of an affiliation going in.
G27. If we already have a defined curriculum, can it be presented as an appendix? Or does it need to be extensively defined in the body of the application?
Given a relatively condensed review period, we really want the applications to be confined to the 20 pages requested. You may refer to a Web site or to the availability of additional material that could subsequently be requested by the reviewers, but we do not want applicants to submit appendices. The call for proposals asks for no appendices. So in terms of defining your curriculum, yes, it does need to be described in the body of the text, but it does not have to be exhaustively documented. It just needs to be described in a clear and comprehensive way.
G28. What material can be included in tables not counted toward the page limit?
Material may include an outline of your curriculum, documentation of your qualifications, and your experience in the field. Keep in mind we are asking applicants to focus their application on the 20 pages of text, an additional table or two, but please do not submit a large number of tables in addition to the 20 pages of text. Providing much more information than is asked for will probably not be viewed positively by the reviewers. People are a lot more likely to want to see an application that is very strong, where it is able to be described clearly and concisely.
G29. What about the organization’s board of trustees, lists, history, financials? Will these be needed to be attached to grants, and if so, are they part of the 20 pages?
No, you do not need to do a lot of documentation of the board of trustees, et cetera. If reviewers have questions regarding the background or the nature of the organization before making final funding recommendations, we will ask for additional information. So you need just in your grant proposal probably to generally describe the applicant organization, but that does not need to be terribly detailed or documented with financials or boards of trustees, et cetera.
G30. There’s no defined section for a description of key personnel and their skills set in the application. What section do you prefer this to be under, or does it simply get placed in the budget justification?
There are two ways of doing that. One is, in the text of your application, you probably should describe the key personnel and their experience and skills and strengths relative to what you are proposing; and then also, in the budget and biographical sketches section of the application, please include biographical sketches of all of your key personnel.
G31. Can you give firmer guidance on page limitations for the figures and tables that may be appended?
Figures and tables should not exceed five pages. I would encourage you to keep any appended materials limited. The reviewers will be looking at a lot of applications, and including a lot of material that is not essential is not going to enhance reviewers’ view of the quality of your proposal. Please also see G27.
G32. If the graphs and tables are added to the end of the document, is it OK for the length of the document to be greater than 20 pages?
The 20 pages refer to background and rationale, pertinent previous and ongoing work of the applicant group and your methods. We are going to be returning applications that are over 20 pages to the applicants. We may give you an opportunity to revise and resubmit it within a very brief time if it is over 20 pages, but we are not going to accept applications that are over 20 pages for those sections under Background and Methods that I mentioned.
G33. The 20-page limit does not include figures and tables. Should we attach these after the main body of the proposal or integrate the tables within the grant?
Probably better to attach them to the end of that section of the grant.
G34. Are there two different types of grants, or is it just one type?
The call for proposals asks for one type of evaluation grant. The evaluation grants will have the eight-month initial phase, and then the 24-month implementation phase, for a total of 32 months.
G35. How many preliminary projects were approved?
We did not go through an actual approval process of preliminary projects. We read through all of the preliminary projects and gave some feedback to some individual projects regarding unclear aspects of their plan and ways they may have appeared not in line with the grant guidelines. No proposal was disapproved per se. Anyone who submitted a brief proposal and wants to submit a full proposal is able to submit a full proposal. Overall, we received over 100 brief proposals on July 1. We are very enc