Objectives We tested the effectiveness of a culturally tailored, behavioral theory–based community health worker intervention for improving glycemic control. Methods We used a randomized, 6-month delayed control group design among 164 African American and Latino adult participants recruited from 2 health systems in Detroit, Michigan. Our study was guided by the principles of community-based participatory research. Hemoglobin A1c (HbA1c) level was the primary outcome measure. Using an empowerment-based approach, community health workers provided participants with diabetes self-management education and regular home visits, and accompanied them to a clinic visit during the 6-month intervention period. Results Participants in the intervention group had a mean HbA1c value of 8.6% at baseline, which improved to a value of 7.8% at 6 months, for an adjusted change of −0.8 percentage points (P<.01). There was no change in mean HbA1c among the control group (8.5%). Intervention participants also had significantly greater improvements in self-reported diabetes understanding compared with the control group. Conclusions This study contributes to the growing evidence for the effectiveness of community health workers and their role in multidisciplinary teams engaged in culturally appropriate health care delivery.

Objectives Among functionally independent patients with diabetes or heart failure, we examined family member support and family-related barriers to self-care. We then identified patient characteristics associated with family support and family barriers and how each was associated with self-management adherence. Methods Cross-sectional survey of 439 patients with diabetes or heart failure (74% response rate). Results 75% of respondents reported supportive family involvement in self-care, however 25% reported frequent family-related barriers to self-care. Women reported family support less often (64% vs. 77%) and family barriers to self-care more often (30% vs. 21%) than men. 78% of respondents reported involved family members nagged or criticized them about illness care. In multivariate models, low health literacy, partnered status, and higher family function were associated with higher family support levels, while female gender, older age, higher education, and more depression symptoms were associated with family barriers to self-care. Family barriers were associated with lower disease care self-efficacy (p<.0.01), and both barriers and family support were associated with patients’ self-management adherence (both p<0.05). Discussion Family members are highly involved in the self-care of these higher-functioning patients. Interventions should help patients with chronic illness overcome family barriers to self-care and help families use positive and effective support techniques.

In general, social support from family members affects chronic illness outcomes, but evidence on which specific family behaviors are most important to adult patient outcomes has not been summarized. We systematically reviewed studies examining the effect of specific family member behaviors and communication patterns on adult chronic illness self-management and clinical outcomes. Thirty studies meeting inclusion criteria were identified, representing 22 participant cohorts, and including adults with arthritis, chronic cardiovascular disease, diabetes, and/or end stage renal disease. Family emphasis on self-reliance and personal achievement, family cohesion, and attentive responses to symptoms were associated with better patient outcomes. Critical, overprotective, controlling, and distracting family responses to illness management were associated with negative patient outcomes. Study limitations included cross-sectional designs (11 cohorts), however results from longitudinal studies were similar. Findings suggest that future interventions aiming to improve chronic illness outcomes should emphasize increased family use of attentive coping techniques and family support for the patient’s autonomous motivation.