Rationale and design of the Miami Healthy Heart Initiative: a randomized controlled study of a community health worker intervention among Latino patients with poorly controlled diabetes

Abstract

BackgroundType 2 diabetes mellitus disproportionately affects the Latino community. Latinos with diabetes are also less likely to have adequate control of cardiovascular risk factors such as cholesterol and blood pressure. Community health workers (CHWs) are increasingly being used to address various health disparity conditions, including diabetes. However, evidence of their effectiveness from randomized controlled trials is limited.MethodsThe Miami Health Heart Initiative is a randomized controlled trial of 300 Latino patients with diabetes. Patients with hemoglobin A1c (HbA1c) ≥8.0% were recruited from Miami-Dade’s public hospital system. At baseline, all patients underwent phlebotomy, physical examination, and a structured 90-minute research interview. They were then randomized to either usual care or a CHW intervention called Cariño. For participants in the Cariño arm of the study, CHW services included assistance with nonmedical social services, health education, and patient navigation in which the CHWs serve as a bridge between patients and the health care system. These services were delivered through home visits, phone calls, and group visits. At 12 months, all subjects had a follow-up examination. The primary outcomes at 1 year are changes in systolic blood pressure, low-density lipoprotein, and HbA1c. Secondary outcomes include medication adherence, medication intensification, diabetes self-efficacy, physical activity, and self-reported fruit and vegetable intake.DiscussionThe Miami Healthy Heart Initiative is one of the first rigorously conducted randomized controlled trials to provide evidence on the impact of CHWs on diabetes intermediate outcomes among Latinos. If the data support our primary hypotheses, the study would lend added support to ongoing efforts to incorporate CHWs as part of our national efforts to reduce and ultimately eliminate health disparities.

Community Health Worker Interventions to Improve Glycemic Control in People with Diabetes: A Systematic Review and Meta-Analysis

“…In addition, the completion of currently ongoing trials should add much needed information, and increase our confidence in meta-analytic estimates. [32][33][34][35][36] The efficacy of CHWs may vary depending on whether they work from within the community, or integrated into multidisciplinary health care teams. The CHWs worked in a team that included other health care professionals, either a nurse practitioner or a diabetes nurse, in only four of the nine long-term studies.…”

Avaliação da efetividade da promoção da atividade física por agentes comunitários de saúde em visitas domiciliares

“…Essas estratégias são oferecidas isoladamente ou combinadas 33,34 . Vale ressaltar que o sistema de saúde norte-americano e, obviamente, muitas das funções e atribuições dos ACS são diferentes em comparação com os ACS do Brasil.…”

Peers as Facilitators of Medication Adherence Interventions

“…13 However, promotoras and CHWs are not typically individuals who are living with the same disease as the target population. 14 …”