Participants' Assessments of the Effects of a Community Health Worker Intervention on Their Diabetes Self-Management and Interactions with Healthcare Providers

Abstract

Background Specific ways community health worker (CHW) programs affect participants’ health care behaviors and interactions with their health care providers, as well as mechanisms by which CHW programs influence these outcomes, are poorly understood. Through a qualitative descriptive study of participants in a successful CHW diabetes self-management program, we sought to answer: 1) What gaps in diabetes care, with a focus on patient-doctor interactions, do participants identify? And 2) How does the program influence participants’ diabetes care and interactions with health care providers, and what gaps, if any, does it address? Methods From 2005-2007, we conducted semi-structured interviews with 40 African American and Latino adults with diabetes who had completed or were active in a CHW-led diabetes self-management program developed and implemented using community-based participatory research (CBPR) principles in Detroit. Interviews were audiotaped, transcribed, and coded through a consensual and iterative process. Results Participants reported that before participating in the intervention they had received inadequate information from health care providers for effective diabetes self-management, had had low expectations for help from their providers, and had not felt comfortable asking questions or making requests of their health care providers. Key ways participants reported that the program improved their ability to manage their diabetes were by providing 1) clear and detailed information on diabetes and diabetes care that they had not known before REACH; 2) education and training on specific strategies to meet diabetes care goals; 3) sustained and non-judgmental assistance to increase their motivation and confidence to improve their diabetes self-management; and 4) social and peer support that enabled them to better manage their diabetes. The knowledge and confidence gained through the CHW intervention increased participants’ assertiveness in asking questions to and requesting necessary tests and results from their providers. Conclusions Our interview findings suggest ways that CHW programs that provide both one-on-one support and group self-management training sessions may be effective in promoting more effective diabetes care and patient-doctor relationships among Latino and African American adults with diabetes. Through these mechanisms, such interventions may help to mitigate racial and ethnic disparities in diabetes care and outcomes.

Peer Coaches to Improve Diabetes Outcomes in Rural Alabama: A Cluster Randomized Trial

“…Peer coaches have been shown to improve asthma, cancer screening and treatment, and diabetes outcomes among low-income minorities. [9][10][11][12][13][14][15][16] It is not known, however, whether peer coaches can be effective in rural, under-resourced settings, where distance barriers are considerable and telephone connections are intermittent, or whether peer coaches are superior to diabetes education alone, especially in areas where basic knowledge about diabetes and healthy lifestyles is low. To fill these gaps in the evidence, we conducted a cluster-randomized trial in a rural, under-resourced region that tested the effectiveness of peer coaches plus brief education compared with brief education alone.…”

Care Guides

“…Another is that improvement in glycemic control takes longer to achieve. Recent reports suggest that regular home visits by culturally matched community health workers may be a more effective model for Latino, African American, and Hawaiian patients with diabetes (Babamato et al, 2009;Beckham et al, 2008;Heisler et al, 2009).…”

CHOICE: Choosing Health Options In Chronic Care Emergencies

“…Forty-two papers were identified as eligible for inclusion in this review: Aroni et al, 189 Becker et al, 190 Cvetkovski et al, 191 Donald et al, 155 Douglass et al, [192][193][194] Goeman et al, 136,195 Griffiths et al, 196 Hyland et al, 197 Jones et al, 198 Tumiel-Berhalter and Zayas, 199 De Vito, 200 Elkington et al, 110 Hopley et al, 201 Shipman et al, 202 Wilson et al, 203 Balcou-Debussche and Debussche, 204 Brez et al, 205 Broom,206 de-Graft, 207 Heisler et al, 208 Johnson et al, 209 Lawton et al, 210 McDowell et al, 211 Perera et al, 212 Mead et al, 213 Paquet et al, 214 Schoenberg and Peters, 215 Cowie et al, 216 Forsyth et al, 217 Fried et al, 218 Gately et al,…”

“…[216][217][218][219]221,222,[224][225][226][227][228] The majority of studies were from the USA (n = 11 190,199,200,208,213,215,217,218,222,224,225 ), Australia (n = 12 136,155,189,[191][192][193][194][195]206,220,221,227 ) or the UK (n = 12 110,196,197,202,[209][210][211]216,219,223,226,228 ). The most frequently studied types of unscheduled care were attendance at the ED and/or EHA.…”

“…In total, 14 studies were of patients with asthma, 136,155,[189][190][191][192][193][194][195][196][197][198][199]212 five were of patients with COPD, 110,[200][201][202][203][204] seven were of patients with diabetes, [205][206][207][208][209][210][211] three were of patients with CHD 213-215 and 11 were of patients with mixed/multiple LTCs. [216][217][218][219]221,222,[224][225][226][227][228] The majority of studies were from the USA (n = 11 190,199,200,208,213,215,217,218,222,224,…”